Provider Demographics
NPI:1528234374
Name:OYELAKIN, ADEBOWALE OLUWOLE (MD)
Entity type:Individual
Prefix:
First Name:ADEBOWALE
Middle Name:OLUWOLE
Last Name:OYELAKIN
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 1:5555 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4622
Mailing Address - Country:US
Mailing Address - Phone:602-865-5561
Mailing Address - Fax:602-862-5567
Practice Address - Street 1:5555 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4622
Practice Address - Country:US
Practice Address - Phone:602-865-5561
Practice Address - Fax:602-862-5567
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40933207RC0200X
NY241024207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ124223Medicare PIN