Provider Demographics
NPI:1669725651
Name:ADEGBEMLE, ADEOLA AJOKE (MD)
Entity type:Individual
Prefix:MS
First Name:ADEOLA
Middle Name:AJOKE
Last Name:ADEGBEMLE
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:615 CASE PL
Mailing Address - Street 2:APT 1
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3533
Mailing Address - Country:US
Mailing Address - Phone:312-607-8427
Mailing Address - Fax:
Practice Address - Street 1:3333 GREEN BAY RD
Practice Address - Street 2:CMS ROSALIND FRANKLIN UNIVERSITY
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3037
Practice Address - Country:US
Practice Address - Phone:224-610-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL120.062265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125.062265OtherTEMPORARY PHYSICIAN LICENSE