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General NPI Number Information
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NPI Number | 1194917310
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Entity Type | Individual
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Provider Name | ADEJARE WINDOKUN MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2007
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1845 MCCULLOCH BLVD N STE A12
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6777
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Country | US
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Telephone | 928-302-1505
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 MCCULLOCH BLVD N STE A12
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6777
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Country | US
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Telephone | 928-302-1505
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Fax | 310-999-6587
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A90058
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01065872A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 41043
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License Number State | AZ
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