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Adesola Awomolo

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NPI Number Detailed Information

Provider Information:

Name: Adesola Awomolo
Gender: F
Provider License Number If Given: 01083014A

NPI Information:

NPI: 1699778894
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 11/18/2019

Provider Business Mailing Address:

Address: 1200 W WHITE RIVER BLVD RCS PROVIDER ENROLLMENT
Muncie, IN 47303
Phone Number: 8776685621
Fax Number:

Provider Business Practice Location Address:

Address: 2401 W UNIVERSITY AVE
Muncie, IN 47303
Phone Number: 7652812030
Fax Number:

Provider Taxonomy:

Primary: 207RX0202X
Secondary (if any): 207RX0202X
State: IN

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