Healthcare Provider Details

I. General information

NPI: 1164813739
Provider Name (Legal Business Name): OLUFUNKE M ADEYEMO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 S WAYNE RD
WAYNE MI
48184-1221
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 734-351-3166
  • Fax:
Mailing address:
  • Phone:
  • Fax: 248-551-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301106696
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: