Provider Demographics
NPI:1275552655
Name:ADELEYE, ANTHONY A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:ADELEYE
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 1:30838 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6856
Mailing Address - Country:US
Mailing Address - Phone:586-944-2115
Mailing Address - Fax:586-777-1031
Practice Address - Street 1:30838 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6856
Practice Address - Country:US
Practice Address - Phone:586-944-2115
Practice Address - Fax:586-777-1031
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404448208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E33946Medicare UPIN
MI0828267Medicare ID - Type Unspecified