Provider Demographics
NPI:1750005153
Name:ADEIGBE, BANKOLE WAHEED I
Entity type:Individual
Prefix:MR
First Name:BANKOLE
Middle Name:WAHEED
Last Name:ADEIGBE
Suffix:I
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 1:7310 FREEPORT LN APT D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-1124
Mailing Address - Country:US
Mailing Address - Phone:463-336-3843
Mailing Address - Fax:
Practice Address - Street 1:7310 FREEPORT LN APT D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-1124
Practice Address - Country:US
Practice Address - Phone:463-336-3843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies