Individual
DR. MOSES O. ADEYANJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
405 W JACKSON ST, PATHOLOGY DEPARTMENT, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 351-4957
Mailing address
PO BOX 1105, INDIANAPOLIS, IN 46206-1105
(618) 457-5200
(618) 351-4821
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036-077955
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077955-2
—
IL
Enumeration date
12/05/2005
Last updated
06/13/2014
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