MEDICARE: DR. OLUWABUNMI D. ADEBAYO APRN

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	163W00000X	Registered Nurse	4704297840	MI
2	163WC0200X	Critical Care Medicine Registered Nurse	000012459474	MI
3	363LA2100X	Acute Care Nurse Practitioner	2018078420	MI
4	363LF0000X	Family Nurse Practitioner	F05190099	MI

General Provider Information

NPI Number	:	1922650787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLUWABUNMI D. ADEBAYO APRN

Provider Business Mailing Address
First Line	:	50 N PERRY ST
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48342-2217
Country	:	US
Telephone Number	:	248-218-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W AVON RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2704
Country	:	US
Telephone Number	:	248-218-2000
Fax Number	:

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

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	09/03/2020

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