Provider Demographics
NPI:1619394186
Name:ADELAJA, OLUWATOBI (MD)
Entity Type:Individual
Prefix:
First Name:OLUWATOBI
Middle Name:
Last Name:ADELAJA
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:ST MICHAEL'S HOSPITAL DEPARTMENT OF PATHOLOGY
Mailing Address - Street 2:900 ILLINOIS AVENUE
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481
Mailing Address - Country:US
Mailing Address - Phone:312-975-6809
Mailing Address - Fax:
Practice Address - Street 1:ST MICHAEL'S HOSPITAL DEPARTMENT OF PATHOLOGY
Practice Address - Street 2:900 ILLINOIS AVENUE
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:312-975-6809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-23
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI80136207ZP0102X, 207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program