MEDICARE: MR. OLUWASEYE ADETULA

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	332B00000X	Durable Medical Equipment & Medical Supplies	0094559	TX

General Provider Information

NPI Number	:	1912199407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OLUWASEYE ADETULA

Provider Business Mailing Address
First Line	:	1506 W PIONEER PKWY STE 201
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 W PIONEER PKWY STE 201
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6200
Country	:	US
Telephone Number	:	817-265-0500
Fax Number	:	817-275-7984

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

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	08/17/2007

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