Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 207V00000X | NY |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036-143019 | IL |
NPI | 1104196641 |
---|---|
Provider Name | Dr. Henry Olugbenga Adekola |
First Address | Springfield, IL 62794-9659 |
Second Address | Springfield, IL 62702-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2011 |
Last Update Date | 26/09/2018 |