Gideon S. Adegbile, M.D.
Individual provider Active NPI Family Medicine Physician · Moraine, OH
NPI 1922061977 · NPPES record last updated Apr 22, 2013
Key facts
- NPI
- 1922061977
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 35-03-4541-A (OH)
- Practice address
- 3033 Kettering Blvd
Suite 100
Moraine, OH 45439-1962 - Phone
- (937) 293-2133
- Fax
- (937) 293-2161
- NPI assigned
- Apr 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Integrated Medical Assoc LTD | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35-03-4541-A | OH | Yes |
Addresses
Primary practice location
3033 Kettering Blvd
Suite 100
Moraine, OH 45439-1962
Mailing address
3033 Kettering Blvd
Suite 100
Moraine, OH 45439-1962
Phone (937) 293-2133
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0214280 | Medicaid | OH | |
| 4016910 | Other | OH | AETNA PROVIDER NUMBER |
| 000000189058 | Other | OH | ANTHEM PROVIDER NUMBER |
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- Akwasi Agyeman-Prempeh
- Rex Alba
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- Marina Alexander
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All providers in Moraine, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.