Provider Demographics
NPI:1740617414
Name:ADEGBORO, CLAUDETTE ONYELOBI (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDETTE
Middle Name:ONYELOBI
Last Name:ADEGBORO
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 1:1010 MOUND ST
Mailing Address - Street 2:ROOM 414
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1532
Mailing Address - Country:US
Mailing Address - Phone:608-417-6831
Mailing Address - Fax:
Practice Address - Street 1:1010 MOUND ST
Practice Address - Street 2:ROOM 414
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1532
Practice Address - Country:US
Practice Address - Phone:608-417-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125064021208000000X
WI65811202080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics