Provider Demographics
NPI:1194003111
Name:ATILADE, ADEOLA GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEOLA
Middle Name:GRACE
Last Name:ATILADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:403 OGLETREE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-9444
Mailing Address - Country:US
Mailing Address - Phone:936-327-5686
Mailing Address - Fax:936-327-8833
Practice Address - Street 1:403 OGLETREE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-9444
Practice Address - Country:US
Practice Address - Phone:936-327-5686
Practice Address - Fax:936-327-8833
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP8114207V00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology