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NPI Code Detail

MEDICARE: DR. CHARLES MOSADOLUWA AYANLEKE MD

MEDICARE: DR. CHARLES MOSADOLUWA AYANLEKE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician65990GA
2208M00000XHospitalist Physician35.093062OH
3207R00000XInternal Medicine PhysicianME109811FL
4208M00000XHospitalist PhysicianME109811FL
5207R00000XInternal Medicine Physician35-093062OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255573960
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES MOSADOLUWA AYANLEKE MD
Provider Business Mailing Address
First Line : PO BOX 746638
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6638
Country : US
Telephone Number : 904-202-2092
Fax Number : 904-376-4075
Provider Business Practice Location Address
First Line : 820 PRUDENTIAL DR STE 304
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8205
Country : US
Telephone Number : 904-202-3860
Fax Number : 904-202-3846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2009
Last Update Date : 06/09/2026

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