Provider Demographics
NPI:1861554842
Name:ADELEKE, ADELEKAN KAMILU (PT)
Entity type:Individual
Prefix:
First Name:ADELEKAN
Middle Name:KAMILU
Last Name:ADELEKE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25940 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-6016
Mailing Address - Country:US
Mailing Address - Phone:313-541-7204
Mailing Address - Fax:313-541-7216
Practice Address - Street 1:32171 MOUND RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3872
Practice Address - Country:US
Practice Address - Phone:313-541-7204
Practice Address - Fax:313-541-7216
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP17550001Medicare ID - Type Unspecified