MEDICARE: ADEFUNKE OLAWAIYE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD433872	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2110417	OTHER	PA	HIGHMARK BCBS

General Provider Information

NPI Number	:	1427080969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEFUNKE OLAWAIYE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1236
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16003-1236
Country	:	US
Telephone Number	:	412-937-8887
Fax Number	:	412-937-9221

Provider Business Practice Location Address
First Line	:	259 MOUNT NEBO POINTE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-1313
Country	:	US
Telephone Number	:	412-366-2367
Fax Number	:	412-366-2368

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/15/2011

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