Individual
GIDEON S. ADEGBILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3033 KETTERING BLVD, SUITE 100, MORAINE, OH 45439-1962
(937) 293-2133
(937) 293-2161
Mailing address
3033 KETTERING BLVD, SUITE 100, MORAINE, OH 45439-1962
(937) 293-2133
(937) 293-2161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-03-4541-A
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000189058
ANTHEM PROVIDER NUMBER
OH
05
—
0214280
—
OH
01
—
4016910
AETNA PROVIDER NUMBER
OH
Enumeration date
04/10/2006
Last updated
04/22/2013
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