Individual
IBINABO DEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1505 EASTLAND DR STE 330, BLOOMINGTON, IL 61701-7912
(309) 662-3311
(309) 662-9709
Mailing address
1505 EASTLAND DR STE 330, BLOOMINGTON, IL 61701-7912
(309) 662-3311
(309) 662-9709
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036169126
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2021
Last updated
07/17/2024
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