Healthcare Provider Details

I. General information

NPI: 1457589350
Provider Name (Legal Business Name): ADETUNJI A. ADARALOYE D.O., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 10TH AVE S POB 1, SUITE 720
BIRMINGHAM AL
35205-1605
US

IV. Provider business mailing address

2660 10TH AVE S POB 1, SUITE 720
BIRMINGHAM AL
35205-1605
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-2456
  • Fax: 205-930-2469
Mailing address:
  • Phone: 205-930-2456
  • Fax: 205-930-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101017983
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1201
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1201
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: