Healthcare Provider Details

I. General information

NPI: 1114507456
Provider Name (Legal Business Name): TOLUWANIMI A OYEDELE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOLUWANIMI A TOLA-ADELANI

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 FERRY ST
LAFAYETTE IN
47904-3021
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 765-449-1555
  • Fax: 765-449-1110
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01094062A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: