Provider Demographics
NPI:1467426940
Name:JAIYEOLA, ADEREMI A (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEREMI
Middle Name:A
Last Name:JAIYEOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REMI
Other - Middle Name:R
Other - Last Name:JAIYEOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:816 22ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2226
Practice Address - Country:US
Practice Address - Phone:308-865-2263
Practice Address - Fax:308-865-2541
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62199207RG0100X
KY33409207RG0100X
NE36062207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201308470Medicaid
KY7100455730Medicaid
IN201308470Medicaid
TXP01031129OtherRR MEDICARE INDIVIDUAL
H24320Medicare UPIN
GA10BDHJVMedicare PIN
TNP00467442Medicare PIN
GA0101OtherUNITED HEALTH CARE
10067571OtherAMERIGROUP
346697OtherWELLCARE
4625862OtherCIGNA
GA574272006BMedicaid
TX031528502Medicaid
7197152OtherAETNA
GA52703976002OtherBLUE SHIELD OF GEORGIA
TN30013101Medicaid
TN30013101Medicare PIN