Provider Demographics
NPI:1619593779
Name:ADEKUNLE, AYOOLUWATOMIWA DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:AYOOLUWATOMIWA
Middle Name:DEBORAH
Last Name:ADEKUNLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE MSC 8124-0086-09
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-362-8940
Mailing Address - Fax:
Practice Address - Street 1:1 BARNES JEWISH PLAZA
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-362-8940
Practice Address - Fax:314-362-3643
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023019805390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program