MEDICARE: DR. ADEMUYIWA ADEKOLA ADETUNJI DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	01264	MD

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

General Provider Information

NPI Number	:	1487638854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADEMUYIWA ADEKOLA ADETUNJI DPM

Provider Business Mailing Address
First Line	:	P.O.BOX 265
Second Line	:
City	:	FULTON
State	:	MD
Zip	:	20759-0265
Country	:	US
Telephone Number	:	301-386-5453
Fax Number	:	301-386-5396

Provider Business Practice Location Address
First Line	:	1450 MERCANTILE LN
Second Line	:	STE 151
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-5376
Country	:	US
Telephone Number	:	301-386-5453
Fax Number	:	301-386-5396

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	05/10/2017

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