Provider Demographics
NPI:1235576257
Name:ILUYOMADE, ADEDAPO ADEYINKA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEDAPO
Middle Name:ADEYINKA
Last Name:ILUYOMADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAPO
Other - Middle Name:
Other - Last Name:ILUYOMADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 198054
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8054
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:
Practice Address - Street 1:7400 SW 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5458
Practice Address - Country:US
Practice Address - Phone:786-204-4201
Practice Address - Fax:786-591-6001
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME146377207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program