Healthcare Provider Details

I. General information

NPI: 1922328079
Provider Name (Legal Business Name): ABIODUN ADEJUMOKE OKIN-AYILEKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 W WALL ST
MIDLAND TX
79701-6710
US

IV. Provider business mailing address

3416 W WALL ST STE 100
MIDLAND TX
79701-6700
US

V. Phone/Fax

Practice location:
  • Phone: 432-400-3066
  • Fax:
Mailing address:
  • Phone: 432-400-3066
  • Fax: 432-400-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10037182
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP4604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: