Provider Demographics
NPI:1043298615
Name:ILUYOMADE, ROTIMI A (MD)
Entity Type:Individual
Prefix:
First Name:ROTIMI
Middle Name:A
Last Name:ILUYOMADE
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 1:900 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1644
Mailing Address - Country:US
Mailing Address - Phone:270-825-5100
Mailing Address - Fax:
Practice Address - Street 1:6922 LITTLE RIVER TPKE STE D
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3285
Practice Address - Country:US
Practice Address - Phone:703-705-9306
Practice Address - Fax:703-890-3114
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221294207P00000X
MDD0042228207P00000X
KY35535174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000521582OtherBCBS
KY64013972Medicaid
KY000000805251OtherBCBS- BAPTIST HEALTH MADISONVILLE
KY000000805251OtherBCBS- BAPTIST HEALTH MADISONVILLE
KYK027451Medicare PIN
KYP00427569Medicare PIN
F64199Medicare UPIN
KY64013972Medicaid