Healthcare Provider Details

I. General information

NPI: 1821087271
Provider Name (Legal Business Name): ADEBOWALE A ADEDIPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD STE 338
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

26908 DETROIT RD SUITE 301
WESTLAKE OH
44145-2398
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-7910
  • Fax: 216-368-7915
Mailing address:
  • Phone: 440-617-1823
  • Fax: 440-617-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3506551
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: