MEDICARE: DR. OLUGBENGA ADEDIPE 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	208000000X	Pediatrics Physician	20415	MS

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	:	1720088016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLUGBENGA ADEDIPE MD

Provider Business Mailing Address
First Line	:	510 HIGHWAY 322
Second Line	:	P O BOX 1216
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-4717
Country	:	US
Telephone Number	:	662-624-4292
Fax Number	:	662-624-4354

Provider Business Practice Location Address
First Line	:	1820 PEABODY ST
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9441
Country	:	US
Telephone Number	:	662-363-3656
Fax Number	:	662-363-3789

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/28/2014

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Directions to “ DR. OLUGBENGA ADEDIPE MD” Practice Location

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