Healthcare Provider Details

I. General information

NPI: 1760551444
Provider Name (Legal Business Name): JOHN A ADESIOYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 N HIGH ST
HILLSBORO OH
45133
US

IV. Provider business mailing address

5605 WESTERVILLE RD SUITE C
WESTERVILLE OH
43081-9395
US

V. Phone/Fax

Practice location:
  • Phone: 937-840-6538
  • Fax:
Mailing address:
  • Phone: 740-794-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD034906
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.090450
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: