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NPI Code Detail

MEDICARE: ADEYOYIN O OKUNADE M.D.

MEDICARE: ADEYOYIN O OKUNADE 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
1207Q00000XFamily Medicine Physician036-101935IL
2207Q00000XFamily Medicine PhysicianP4217TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2P4217OTHERTXSTATE BOARD LICENSE

General Provider Information

NPI Number : 1407967359
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADEYOYIN O OKUNADE M.D.
Provider Business Mailing Address
First Line : 2423 WILLIAMS DR STE 107
Second Line :
City : GEORGETOWN
State : TX
Zip : 78628-3269
Country : US
Telephone Number : 877-800-5722
Fax Number :
Provider Business Practice Location Address
First Line : 8913 COLLINFIELD DR UNIT 1
Second Line :
City : AUSTIN
State : TX
Zip : 78758-6704
Country : US
Telephone Number : 877-800-5722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/16/2025

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