Provider Demographics
NPI:1801240445
Name:ADELAKUN, ADEKUNBI ABOSEDE (MD)
Entity type:Individual
Prefix:
First Name:ADEKUNBI
Middle Name:ABOSEDE
Last Name:ADELAKUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29255 NORTHWESTERN HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5740
Mailing Address - Country:US
Mailing Address - Phone:248-358-2410
Mailing Address - Fax:
Practice Address - Street 1:29255 NORTHWESTERN HWY STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5740
Practice Address - Country:US
Practice Address - Phone:248-358-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015005262080P0201X, 208000000X, 2080P0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/ImmunologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty