Provider Demographics
NPI:1821087271
Name:ADEDIPE, ADEBOWALE A (MD)
Entity Type:Individual
Prefix:
First Name:ADEBOWALE
Middle Name:A
Last Name:ADEDIPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:11201 SHAKER BLVD
Practice Address - Street 2:STE 338
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3869
Practice Address - Country:US
Practice Address - Phone:216-368-7910
Practice Address - Fax:216-368-7915
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2009-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH3506551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0949504Medicaid
OH0949504Medicaid