MEDICARE: ADEYEMI T GBOHUNMI M.D., PH.D.

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	208D00000X	General Practice Physician	T9873	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1982165155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEYEMI T GBOHUNMI M.D., PH.D.

Provider Business Mailing Address
First Line	:	1301 E DEBBIE LN # 102-8
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-3305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6913 CAMP BOWIE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7163
Country	:	US
Telephone Number	:	708-505-9364
Fax Number	:

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

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	12/15/2025

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