Provider Demographics
NPI:1205217965
Name:OBAYEMI, ADETOKUNBO JR (MD)
Entity Type:Individual
Prefix:
First Name:ADETOKUNBO
Middle Name:
Last Name:OBAYEMI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ADE
Other - Middle Name:
Other - Last Name:OBAYEMI
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2342
Mailing Address - Country:US
Mailing Address - Phone:315-464-7279
Mailing Address - Fax:315-464-7282
Practice Address - Street 1:750 EAST ADAMS STREET
Practice Address - Street 2:CWB RM 251
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:201-431-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308888207Y00000X, 208600000X, 207YX0905X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program