Individual
ADEKUNLE GBADEGESIN KUKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01062251A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09674381
—
CO
05
—
129017
—
AZ
05
—
17521246
—
NM
Enumeration date
08/21/2006
Last updated
04/09/2021
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