Provider Demographics
NPI:1972601607
Name:LADIPO, ADETOKUNBO OLUSOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADETOKUNBO
Middle Name:OLUSOLA
Last Name:LADIPO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1541
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202
Mailing Address - Country:US
Mailing Address - Phone:256-236-3031
Mailing Address - Fax:256-236-3202
Practice Address - Street 1:1306 LEIGHTON AVE.
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207
Practice Address - Country:US
Practice Address - Phone:256-236-3031
Practice Address - Fax:256-236-3202
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL109509Medicaid
AL1417168485OtherOMNI CLINIC GROUP NPI
AL1326259300OtherOMNI CLINIC OF SLYACAUGA
AL009938730Medicaid
AL051517112Medicaid
ALG81388Medicare UPIN
AL0515100015Medicare ID - Type Unspecified
AL109509Medicaid