MEDICARE: DR. ADEDOYIN OKUSANYA 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	208D00000X	General Practice Physician	ME129198	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

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

General Provider Information

NPI Number	:	1962713461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADEDOYIN OKUSANYA MD

Provider Business Mailing Address
First Line	:	8116 RIVERMONT WAY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637
Country	:	US
Telephone Number	:	813-482-5734
Fax Number	:

Provider Business Practice Location Address
First Line	:	6613 49TH ST N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5728
Country	:	US
Telephone Number	:	727-527-6611
Fax Number	:

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

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	02/13/2017

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