Provider Demographics
NPI:1740025758
Name:ADEMAKINWA, ADEBISI ISAAC
Entity type:Individual
Prefix:
First Name:ADEBISI
Middle Name:ISAAC
Last Name:ADEMAKINWA
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 1:6534 GULFWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-7521
Mailing Address - Country:US
Mailing Address - Phone:317-480-6265
Mailing Address - Fax:
Practice Address - Street 1:3850 SHORE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5621
Practice Address - Country:US
Practice Address - Phone:317-529-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015421A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health