Provider Demographics
NPI:1093962466
Name:JOLAYEMI, ADEOLA A (MD)
Entity Type:Individual
Prefix:
First Name:ADEOLA
Middle Name:A
Last Name:JOLAYEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADEOLA
Other - Middle Name:A
Other - Last Name:OYELOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:257 W SAINT GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54840-7827
Mailing Address - Country:US
Mailing Address - Phone:715-463-5317
Mailing Address - Fax:715-463-7335
Practice Address - Street 1:257 W SAINT GEORGE AVE
Practice Address - Street 2:
Practice Address - City:GRANTSBURG
Practice Address - State:WI
Practice Address - Zip Code:54840-7827
Practice Address - Country:US
Practice Address - Phone:715-463-5317
Practice Address - Fax:715-463-7335
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1093962466Medicaid
WI35363100Medicaid
WI35363100Medicaid