Healthcare Provider Details

I. General information

NPI: 1437211828
Provider Name (Legal Business Name): ABIOLA DIANNE ADISA-OBAYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIOLA DIANNE OBAYAN M.D.

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26333 SOUTHFIELD RD STE 103
LATHRUP VILLAGE MI
48076-4574
US

IV. Provider business mailing address

26333 SOUTHFIELD RD STE 103
LATHRUP VILLAGE MI
48076-4574
US

V. Phone/Fax

Practice location:
  • Phone: 248-331-1900
  • Fax:
Mailing address:
  • Phone: 248-331-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAA062397
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: