Healthcare Provider Details

I. General information

NPI: 1639866403
Provider Name (Legal Business Name): OLUKEMI ABIKE ALEGI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUKEMI ABIKE DADA MD

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 PRINCE AVENUE, SUITE 102
ATHENS GA
30606
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-7055
  • Fax:
Mailing address:
  • Phone: 319-384-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberR-13021
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: