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Organization
MOBILE MEDICAL PROVIDER INC
Active
Organization
MOBILE MEDICAL PROVIDER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADESHOLA ABDULWAHID AFOLABI NURSE PRACTITIONER (PRESIDENT/CEO)
(317) 588-1039
Entity
Organization
Contact information
Practice address
12045 BODLEY PLACE, FISHERS, IN 46037-3714
(317) 588-1039
(317) 436-7002
Mailing address
12045 BODLEY PLACE, FISHERS, IN 46037-3714
(317) 588-1039
(317) 436-7002
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
NULL
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
NULL
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
2084H0002X
Hospice and Palliative Medicine (Psychiatry & Neurology) Physician
—
NULL
2084H0002X
Hospice and Palliative Medicine (Psychiatry & Neurology) Physician
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
363LF0000X
Family Nurse Practitioner
28204676A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000826011
ANTHEM
IN
01
—
12544963
CAQH
IN
05
—
201176490
—
IN
Enumeration date
04/20/2015
Last updated
08/14/2020
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