Provider Demographics
NPI:1649213455
Name:ADELEYE, JAIYEOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIYEOLA
Middle Name:
Last Name:ADELEYE
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 1:785 OHIO AVE STE 3G
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6215
Mailing Address - Country:US
Mailing Address - Phone:662-624-5026
Mailing Address - Fax:662-624-5028
Practice Address - Street 1:785 OHIO AVE STE 3G
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6215
Practice Address - Country:US
Practice Address - Phone:662-624-5026
Practice Address - Fax:662-624-5028
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18718208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00253023Medicaid
MS00253023Medicaid
I44254Medicare UPIN