Provider Demographics
NPI:1669664579
Name:ALADESAWE, AKINWUMI GAMMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:AKINWUMI
Middle Name:GAMMAL
Last Name:ALADESAWE
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 1:4753 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4945
Mailing Address - Country:US
Mailing Address - Phone:727-807-9948
Mailing Address - Fax:727-807-9950
Practice Address - Street 1:4753 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4945
Practice Address - Country:US
Practice Address - Phone:727-807-9948
Practice Address - Fax:727-807-9950
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1127662081P2900X, 208VP0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHE343ZMedicare PIN