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General NPI Number Information
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NPI Number | 1073567251
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Entity Type | Individual
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Provider Name | OLUFEMI ADELEYE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 1890 GOODMAN RD E SUITE 101
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9504
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Country | US
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Telephone | 662-536-1892
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 366
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City | SOUTHAVEN
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State | MS
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Zip | 38671-0005
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Country | US
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Telephone | 901-681-9895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 18315
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18315
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License Number State | MS
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