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General NPI Number Information
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NPI Number | 1790192185
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Entity Type | Organization
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Legal Business Name | ALADESAWE ENTERPRISES INC.
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 4753 US HIGHWAY 19
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4945
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Country | US
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Telephone | 727-807-9948
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Fax | 727-807-9950
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Provider Business Mailing Address
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Address Line | 4753 US HIGHWAY 19
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4945
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Country | US
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Telephone | 727-807-9948
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Fax | 727-807-9950
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. AKINWUMI GAMMAL ALADESAWE
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Credential | M.D.
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Telephone | 813-368-3387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME112766
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License Number State | FL
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