Provider Demographics
NPI:1578515607
Name:ADELEYE, ADEBOWALE (MD)
Entity Type:Individual
Prefix:
First Name:ADEBOWALE
Middle Name:
Last Name:ADELEYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MISTY RIVER LN SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-3123
Mailing Address - Country:US
Mailing Address - Phone:256-461-1400
Mailing Address - Fax:314-754-9148
Practice Address - Street 1:1201 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3337
Practice Address - Country:US
Practice Address - Phone:256-341-2909
Practice Address - Fax:256-301-0053
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001027302208M00000X
ALMD28097207P00000X
AL28097208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051558947Medicaid
AL109026Medicaid
AL515-97242OtherBCBS
MO205706203Medicaid
AL051558947Medicaid
MOH35624Medicare UPIN
MO205706203Medicaid
AL102I118139Medicare PIN
MO000095376Medicare PIN
AL510I1100374Medicare PIN