Healthcare Provider Details

I. General information

NPI: 1164817748
Provider Name (Legal Business Name): BABAWANDE ADESIBIKAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S COULTER ST
AMARILLO TX
79106-1840
US

IV. Provider business mailing address

1000 S COULTER ST
AMARILLO TX
79106-1840
US

V. Phone/Fax

Practice location:
  • Phone: 806-212-4535
  • Fax:
Mailing address:
  • Phone: 806-212-6604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberV9450
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: