Healthcare Provider Details

I. General information

NPI: 1619593779
Provider Name (Legal Business Name): AYOOLUWATOMIWA DEBORAH ADEKUNLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROGRESS POINT PKWY
O FALLON MO
63368-2205
US

IV. Provider business mailing address

2 PROGRESS POINT PKWY
O FALLON MO
63368-2205
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-9355
  • Fax:
Mailing address:
  • Phone: 636-692-8935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2026022697
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: