Basic Information
| Provider Information | |||||||||
| NPI: | 1679101497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AWUJOOLA | ||||||||
| FirstName: | ADEOLA | ||||||||
| MiddleName: | OLUBUKOLA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2924 CHESTNUT LN APT 1 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376015192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236766321 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 GRAND CONCOURSE | ||||||||
| Address2: | BRONX-LEBANON HOSPITAL CENTER | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185901800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2020 | ||||||||
| LastUpdateDate: | 03/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NY | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.