Healthcare Provider Details

I. General information

NPI: 1386174357
Provider Name (Legal Business Name): BOLANLE ADEBIYI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SE 1ST AVE STE 102
OCALA FL
34471-0478
US

IV. Provider business mailing address

1202 SW 17TH ST STE 201
OCALA FL
34471-1283
US

V. Phone/Fax

Practice location:
  • Phone: 352-505-1301
  • Fax: 352-505-9846
Mailing address:
  • Phone: 352-505-1301
  • Fax: 352-505-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME130997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: