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General NPI Number Information
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NPI Number | 1952614851
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Entity Type | Individual
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Provider Name | OLUBUKOLA ABIGAIL ADELOLA M.D
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Gender | Female
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Dates
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Enumeration Date | 07/20/2010
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 4463 STATE ROUTE 66
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City | MINSTER
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State | OH
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Zip | 45865-8727
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Country | US
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Telephone | 419-628-3821
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Fax | 419-628-9501
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Provider Business Mailing Address
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Address Line | 1002 S KNOXVILLE AVE
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City | SAINT MARYS
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State | OH
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Zip | 45885-2607
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Country | US
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Telephone | 419-394-3387
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Fax | 419-394-9575
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 321554
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.099923
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License Number State | OH
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