Healthcare Provider Details

I. General information

NPI: 1902043078
Provider Name (Legal Business Name): DR ADEBOWALE ADELEYE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 7TH ST SE
DECATUR AL
35601-3337
US

IV. Provider business mailing address

131 MISTY RIVER LN SW
HUNTSVILLE AL
35824-3123
US

V. Phone/Fax

Practice location:
  • Phone: 256-341-2909
  • Fax: 256-301-0053
Mailing address:
  • Phone: 256-464-6441
  • Fax: 256-464-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number28097
License Number StateAL

VIII. Authorized Official

Name: DR. ADEBOWALE ADETOLA ADELEYE
Title or Position: SOLE MEMBER
Credential: MD
Phone: 256-464-6441