Provider Demographics
NPI:1578510921
Name:ARIYO, ADENIRAN ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ADENIRAN
Middle Name:ABRAHAM
Last Name:ARIYO
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:PO BOX 192591
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-8523
Mailing Address - Country:US
Mailing Address - Phone:972-962-2498
Mailing Address - Fax:972-287-7807
Practice Address - Street 1:3535 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3461
Practice Address - Country:US
Practice Address - Phone:972-223-0550
Practice Address - Fax:972-223-0551
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141219902Medicaid
TX0030JQOtherBCBS ID NUMBER
TX167112501Medicaid
TX00501UMedicare ID - Type UnspecifiedGROUP NUMBER
TX141219902Medicaid
TX8H1410Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER