Healthcare Provider Details

I. General information

NPI: 1407967359
Provider Name (Legal Business Name): ADEYOYIN O OKUNADE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOLA OKUNADE M.D.

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8913 COLLINFIELD DR UNIT 1
AUSTIN TX
78758-6704
US

IV. Provider business mailing address

2423 WILLIAMS DR STE 107
GEORGETOWN TX
78628-3269
US

V. Phone/Fax

Practice location:
  • Phone: 877-800-5722
  • Fax:
Mailing address:
  • Phone: 877-800-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-101935
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP4217
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: