Provider Demographics
NPI:1144048083
Name:AJIBADE, DAUDA ADEKUNLE (CEO)
Entity type:Individual
Prefix:
First Name:DAUDA
Middle Name:ADEKUNLE
Last Name:AJIBADE
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-8041
Mailing Address - Country:US
Mailing Address - Phone:317-665-4964
Mailing Address - Fax:
Practice Address - Street 1:755 LOCUST DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-8041
Practice Address - Country:US
Practice Address - Phone:317-665-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider