Provider Demographics
NPI:1346092723
Name:OREBAYO, EMMANUEL ADEBISI, DEMILADE (DO)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:ADEBISI, DEMILADE
Last Name:OREBAYO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11853 160TH ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-7154
Mailing Address - Country:US
Mailing Address - Phone:320-291-8703
Mailing Address - Fax:
Practice Address - Street 1:1705 E 19TH ST STE 703
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5418
Practice Address - Country:US
Practice Address - Phone:918-382-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program