Provider Demographics
NPI:1598758906
Name:AYOADE, AYODELE OLUSEGUN (MD)
Entity Type:Individual
Prefix:DR
First Name:AYODELE
Middle Name:OLUSEGUN
Last Name:AYOADE
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 1:7808 CLODUS FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2206
Mailing Address - Country:US
Mailing Address - Phone:972-770-1032
Mailing Address - Fax:469-484-2126
Practice Address - Street 1:7808 CLODUS FIELDS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2206
Practice Address - Country:US
Practice Address - Phone:972-770-1032
Practice Address - Fax:469-484-2126
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361114172084P0800X
TXN88842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036111417Medicaid
I17654Medicare UPIN
ILK10576Medicare ID - Type Unspecified