Individual
ADEWALE A. FAWOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2955 BROWNWOOD BLVD STE 107, THE VILLAGES, FL 32163-2040
(352) 765-7100
(352) 430-0210
Mailing address
PO BOX 102222, ATTN CREDENTIALING@FLCANCER.COM, ATLANTA, GA 30368-2222
(239) 274-8200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME134275
FL
207RH0000X
Hematology (Internal Medicine) Physician
ME134275
FL
207RX0202X
Medical Oncology Physician
Primary
ME134275
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023178100
—
FL
Enumeration date
07/08/2009
Last updated
03/26/2025
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