Provider Demographics
NPI:1760973812
Name:IJIDAKINRO, ADETOLUWA EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:ADETOLUWA
Middle Name:EMMANUEL
Last Name:IJIDAKINRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9300 CONROY WINDERMERE RD UNIT 161
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5007
Mailing Address - Country:US
Mailing Address - Phone:407-900-8098
Mailing Address - Fax:407-900-8098
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:407-498-5274
Practice Address - Fax:407-900-8098
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.07182207R00000X
FLME154446208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine