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NPI Code Detail

MEDICARE: DR. ADELUOLA G LIPEDE M.D.

MEDICARE: DR. ADELUOLA G LIPEDE M.D.
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
1208600000XSurgery PhysicianR7F89MO
2208D00000XGeneral Practice PhysicianR7F89MO
3208VP0014XInterventional Pain Medicine PhysicianR7F89MO

General Provider Information

NPI Number : 1376503250
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADELUOLA G LIPEDE M.D.
Provider Business Mailing Address
First Line : PO BOX 3980
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63006-3980
Country : US
Telephone Number : 314-522-1888
Fax Number : 314-522-9674
Provider Business Practice Location Address
First Line : 9231 W FLORISSANT AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-1422
Country : US
Telephone Number : 314-522-1888
Fax Number : 314-522-9674
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 11/14/2007

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