MEDICARE: ADEDEJI ASSOCIATES PLLC

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	208600000X	Surgery Physician	Q0719	TX

General Provider Information

NPI Number	:	1740708957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADEDEJI ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	11212 STATE HWY 151
Second Line	:	SUITE 200 MEDICAL PLAZA 1
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251
Country	:	US
Telephone Number	:	210-339-2293
Fax Number	:	844-427-8169

Provider Business Practice Location Address
First Line	:	11212 STATE HIGHWAY 151
Second Line	:	STE 200 MEDICAL PLAZA 1
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4504
Country	:	US
Telephone Number	:	210-339-2293
Fax Number	:	844-427-8169

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	DR. ADEBUKOLA A ADEDEJI
Credential	:	MD
Telephone Number	:	210-339-2293

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	07/21/2022

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