Provider Demographics
NPI:1902043078
Name:DR ADEBOWALE ADELEYE LTD
Entity Type:Organization
Organization Name:DR ADEBOWALE ADELEYE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBOWALE
Authorized Official - Middle Name:ADETOLA
Authorized Official - Last Name:ADELEYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-464-6441
Mailing Address - Street 1:131 MISTY RIVER LN SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-3123
Mailing Address - Country:US
Mailing Address - Phone:256-464-6441
Mailing Address - Fax:256-464-6441
Practice Address - Street 1:1201 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3337
Practice Address - Country:US
Practice Address - Phone:256-341-2909
Practice Address - Fax:256-301-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28097208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH35624Medicare UPIN
IL703430Medicare PIN