Healthcare Provider Details

I. General information

NPI: 1982950937
Provider Name (Legal Business Name): OLUWAROTIMI A ADEPOJU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507A OLD BRANDON RD
PEARL MS
39208-4604
US

IV. Provider business mailing address

1230 FLORIDA DR
ARLINGTON TX
76015-2378
US

V. Phone/Fax

Practice location:
  • Phone: 601-531-8020
  • Fax:
Mailing address:
  • Phone: 813-775-5120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35130417
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35130417
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ6804
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number27217
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: