Healthcare Provider Details

I. General information

NPI: 1669113031
Provider Name (Legal Business Name): OLANREWAJU KAYODE ADABALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 KIMEL PARK DR
WINSTON SALEM NC
27103-6946
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-277-2000
  • Fax: 336-277-2050
Mailing address:
  • Phone: 331-718-1803
  • Fax: 336-718-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2026-03307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: