Provider Demographics
NPI:1760589303
Name:ADEWUYI, ADEREMI (MD)
Entity Type:Individual
Prefix:
First Name:ADEREMI
Middle Name:
Last Name:ADEWUYI
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 1:632 MUSTANG RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4208
Mailing Address - Country:US
Mailing Address - Phone:972-384-0273
Mailing Address - Fax:972-384-0273
Practice Address - Street 1:632 MUSTANG RIDGE DR
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4208
Practice Address - Country:US
Practice Address - Phone:972-384-0273
Practice Address - Fax:972-384-0273
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0631207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH55499Medicare UPIN
NYH55499Medicare UPIN