Provider Demographics
NPI:1326000456
Name:ODUNLAMI, ADEBAYO (MD FAAP)
Entity Type:Individual
Prefix:
First Name:ADEBAYO
Middle Name:
Last Name:ODUNLAMI
Suffix:
Gender:M
Credentials:MD FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6523
Mailing Address - Country:US
Mailing Address - Phone:352-433-2633
Mailing Address - Fax:352-433-2644
Practice Address - Street 1:307 SW 14TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6523
Practice Address - Country:US
Practice Address - Phone:352-433-2633
Practice Address - Fax:352-433-2644
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101959208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000044901Medicaid
FL000044900Medicaid