Healthcare Provider Details

I. General information

NPI: 1659564268
Provider Name (Legal Business Name): ADESOJI ADEOLU ADENIGBAGBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 NW CORPORATE BLVD SUITE 270
BOCA RATON FL
33431-8542
US

IV. Provider business mailing address

1875 NW CORPORATE BLVD SUITE 270
BOCA RATON FL
33431-8542
US

V. Phone/Fax

Practice location:
  • Phone: 561-997-0821
  • Fax: 561-997-0849
Mailing address:
  • Phone: 561-997-0821
  • Fax: 561-997-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101255133
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME102912
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2014-01887
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number002798
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME102912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: