=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962030676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLANREWAJU IDRIS ADEKOLA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2020
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 38 6TH AVE FL 4
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11217-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-362-3260
-----------------------------------------------------
Fax | 718-230-4235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 38 6TH AVE FL 4
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11217-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-362-3260
-----------------------------------------------------
Fax | 718-230-4235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD61333179
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 326137
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------