Provider Demographics
NPI:1679795280
Name:ADEWUSI, ADEDOTUN A (MD)
Entity Type:Individual
Prefix:
First Name:ADEDOTUN
Middle Name:A
Last Name:ADEWUSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3717
Mailing Address - Country:US
Mailing Address - Phone:916-854-6975
Mailing Address - Fax:916-854-6844
Practice Address - Street 1:3901 LONE TREE WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6200
Practice Address - Country:US
Practice Address - Phone:925-756-1192
Practice Address - Fax:925-779-7220
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442593208M00000X, 207R00000X, 208000000X
NY249539208M00000X, 207R00000X, 208000000X
CAC135329208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics