Individual
ADEYEMI O SOBOWALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 SIXTH ST SW, CANTON, OH 44710-1702
(330) 438-7430
(330) 580-5542
Mailing address
2600 SIXTH ST SW, CANTON, OH 44710-1702
(330) 438-7430
(330) 580-5542
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
35074320
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0759746
MEDICAID GROUP NUMBER
OH
01
—
1275635351
GROUP NPI
—
05
—
2131197
—
OH
Enumeration date
11/15/2005
Last updated
05/25/2012
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