Provider Demographics
NPI:1003980475
Name:SIYANBADE, OYETUNDE O (MD)
Entity Type:Individual
Prefix:
First Name:OYETUNDE
Middle Name:O
Last Name:SIYANBADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 PEASE ST
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8307
Mailing Address - Country:US
Mailing Address - Phone:956-698-5138
Mailing Address - Fax:956-698-4080
Practice Address - Street 1:844 CENTRAL BLVD STE 260
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7535
Practice Address - Country:US
Practice Address - Phone:956-435-0344
Practice Address - Fax:956-435-0420
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9913208600000X, 2086S0129X
TXR0326208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13327Medicaid
TX367580301Medicaid
TX539654YKRCMedicare PIN
TX367580301Medicaid
NDN719230Medicare PIN