Provider Demographics
NPI:1982999751
Name:ADEKUGBE, ANNA EJUILE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:EJUILE
Last Name:ADEKUGBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 TREADWAY RD
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2856
Mailing Address - Country:US
Mailing Address - Phone:617-308-1720
Mailing Address - Fax:
Practice Address - Street 1:8933 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3134
Practice Address - Country:US
Practice Address - Phone:219-838-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072692A208000000X
IL125057555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201190960Medicaid
IN193380017Medicare UPIN
IN201190960Medicaid