Healthcare Provider Details

I. General information

NPI: 1639737273
Provider Name (Legal Business Name): ADEDEJI A ONITIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 E COLONIAL DR STE 100
ORLANDO FL
32817-4656
US

IV. Provider business mailing address

14667 GLADE HILL PARK WAY
WINTER GARDEN FL
34787-3264
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4827
  • Fax:
Mailing address:
  • Phone: 352-804-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1164
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21352
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: