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General NPI Number Information
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NPI Number | 1598907925
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Entity Type | Individual
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Provider Name | ANTHONIA D ADEWOLE M.D
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Gender | Female
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 2120 PRAIRIE DR STE 502
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City | PROSPER
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State | TX
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Zip | 75078-3820
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Country | US
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Telephone | 469-447-4893
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Fax | 469-447-4925
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Provider Business Mailing Address
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Address Line | 2120 PRAIRIE DR STE 502
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City | PROSPER
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State | TX
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Zip | 75078-3820
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Country | US
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Telephone | 469-447-4893
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Fax | 469-447-4925
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | SSN/ITIN DELETED
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 073405
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | T9330
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License Number State | TX
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