Healthcare Provider Details

I. General information

NPI: 1265545875
Provider Name (Legal Business Name): ADELO E AQUINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N OAK AVE
RULEVILLE MS
38771-3627
US

IV. Provider business mailing address

PO BOX 506
RULEVILLE MS
38771-0506
US

V. Phone/Fax

Practice location:
  • Phone: 662-756-2747
  • Fax: 662-756-2478
Mailing address:
  • Phone: 662-756-2747
  • Fax: 662-756-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number08983
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: