Provider Demographics
NPI:1255176194
Name:ADEBAYO, BAMIDELE OLUDELE (MD)
Entity type:Individual
Prefix:
First Name:BAMIDELE
Middle Name:OLUDELE
Last Name:ADEBAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12631 E 17TH AVE, C307
Mailing Address - Street 2:5TH FLOOR, ROOM 5009
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-594-3103
Mailing Address - Fax:
Practice Address - Street 1:12631 E 17TH AVE, C307
Practice Address - Street 2:5TH FLOOR, ROOM 5009
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-594-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0010059390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program