Provider Demographics
NPI:1962497537
Name:ADELEKUN, TEMIDAYO A (MD)
Entity Type:Individual
Prefix:DR
First Name:TEMIDAYO
Middle Name:A
Last Name:ADELEKUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:502 W KING ST
Mailing Address - Street 2:LL#20
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-3362
Mailing Address - Country:US
Mailing Address - Phone:704-730-8461
Mailing Address - Fax:704-730-8349
Practice Address - Street 1:502 W KING ST
Practice Address - Street 2:LL#20
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-3362
Practice Address - Country:US
Practice Address - Phone:704-730-8461
Practice Address - Fax:704-730-8349
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200001048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891276GMedicaid
NCH33197Medicare UPIN
NC891276GMedicaid