MEDICARE: OPEYEMI FAKAYODE MD

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	390200000X	Student in an Organized Health Care Education/Training Program		MI

General Provider Information

NPI Number	:	1790328698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OPEYEMI FAKAYODE MD

Provider Business Mailing Address
First Line	:	12000 E 12 MILE RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-3570
Country	:	US
Telephone Number	:	248-207-4849
Fax Number	:	248-546-2604

Provider Business Practice Location Address
First Line	:	27650 DEQUINDRE RD STE 3100
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48092-2818
Country	:	US
Telephone Number	:	248-546-2600
Fax Number	:	248-546-2604

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

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	04/08/2026

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