Provider Demographics
NPI:1588685770
Name:ADEKOLA, ADEKUNLE (MD)
Entity Type:Individual
Prefix:
First Name:ADEKUNLE
Middle Name:
Last Name:ADEKOLA
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 1:475 ELM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3764
Mailing Address - Country:US
Mailing Address - Phone:214-222-3601
Mailing Address - Fax:
Practice Address - Street 1:475 ELM ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3762
Practice Address - Country:US
Practice Address - Phone:214-222-3571
Practice Address - Fax:214-222-3601
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9773207RP1001X, 207RC0200X, 207RC0200X, 207RP1001X
NY234447207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00799177OtherRR MEDICARE PTAN
TXTPI 1979403-01Medicaid
TX8L23883Medicare PIN
TXP00799177OtherRR MEDICARE PTAN
NY351AC1Medicare ID - Type Unspecified
TXTPI 1979403-01Medicaid