MEDICARE: ABOSEDE OLATOYOSI ADEOSHUN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME136266	FL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME136266	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033554902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABOSEDE OLATOYOSI ADEOSHUN M.D.

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-434-6555
Fax Number	:	321-951-7408

Provider Business Practice Location Address
First Line	:	389 COMMERCE PKWY STE 120
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4202
Country	:	US
Telephone Number	:	321-434-6555
Fax Number	:	321-434-6557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	06/28/2024

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