Provider Demographics
NPI:1821576265
Name:AKINBODE, ADEBAYO KAREEM
Entity Type:Individual
Prefix:
First Name:ADEBAYO
Middle Name:KAREEM
Last Name:AKINBODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4008
Mailing Address - Country:US
Mailing Address - Phone:216-240-0737
Mailing Address - Fax:
Practice Address - Street 1:14300 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4008
Practice Address - Country:US
Practice Address - Phone:216-240-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154707-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse