MEDICARE: OLANREWAJU ADEOSUN MD

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	203510	NY

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	2506487	OTHER	NY	GHI
3	OH351	OTHER	NY	BLUE CROSS

General Provider Information

NPI Number	:	1174648489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLANREWAJU ADEOSUN MD

Provider Business Mailing Address
First Line	:	1711 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236
Country	:	US
Telephone Number	:	347-276-6234
Fax Number	:	718-649-6357

Provider Business Practice Location Address
First Line	:	1711 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3319
Country	:	US
Telephone Number	:	347-276-6234
Fax Number	:	718-649-6357

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	01/21/2021

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