Provider Demographics
NPI:1083107239
Name:OYEGBADE, ADEYEMI OLUREMI (MD)
Entity Type:Individual
Prefix:
First Name:ADEYEMI
Middle Name:OLUREMI
Last Name:OYEGBADE
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 1:2269 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3367
Mailing Address - Country:US
Mailing Address - Phone:219-944-4187
Mailing Address - Fax:219-944-4186
Practice Address - Street 1:2269 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3367
Practice Address - Country:US
Practice Address - Phone:199-444-1872
Practice Address - Fax:219-944-4186
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT216389207Q00000X
IN01086286A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine