MEDICARE: ADESOLA AWOMOLO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	200101004	NC
2	207RX0202X	Medical Oncology Physician	01083014A	IN

General Provider Information

NPI Number	:	1699778894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADESOLA AWOMOLO MD

Provider Business Mailing Address
First Line	:	3555 10TH CT
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 36TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4862
Country	:	US
Telephone Number	:	772-567-4673
Fax Number	:	772-400-6932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	08/16/2023

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