Individual
MR. ADEYINKA MARK FAGBAMILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.SC RPT
Contact information
Practice address
20510 FENKELL ST, DETROIT, MI 48223-1613
(313) 534-6611
Mailing address
26696 ISLEWORTH PT, SOUTHFIELD, MI 48034-5670
(313) 492-1946
(248) 799-7645
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501009139
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4693548
—
MI
Enumeration date
08/28/2006
Last updated
07/08/2007
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