MEDICARE: MR. BANKOLE WAHEED ADEIGBE I

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
1	332BN1400X	Nursing Facility Supplies (DME)

General Provider Information

NPI Number	:	1750005153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BANKOLE WAHEED ADEIGBE I

Provider Business Mailing Address
First Line	:	7310 FREEPORT LN APT D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1124
Country	:	US
Telephone Number	:	463-336-3843
Fax Number	:

Provider Business Practice Location Address
First Line	:	7310 FREEPORT LN APT D
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1124
Country	:	US
Telephone Number	:	463-336-3843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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