Provider Demographics
NPI:1558943027
Name:TEJUOSO, ADEMILOLA T
Entity Type:Individual
Prefix:
First Name:ADEMILOLA
Middle Name:T
Last Name:TEJUOSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY STE 270
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2040
Mailing Address - Country:US
Mailing Address - Phone:502-588-4299
Mailing Address - Fax:
Practice Address - Street 1:501 E BROADWAY STE 270
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2040
Practice Address - Country:US
Practice Address - Phone:502-588-4299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program