Provider Demographics
NPI:1790952836
Name:OYERINDE, KOYEJO A (MD)
Entity Type:Individual
Prefix:
First Name:KOYEJO
Middle Name:A
Last Name:OYERINDE
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:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-0997
Mailing Address - Country:US
Mailing Address - Phone:701-858-1800
Mailing Address - Fax:701-857-8056
Practice Address - Street 1:2111 LANDMARK CIR
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1967
Practice Address - Country:US
Practice Address - Phone:701-858-1800
Practice Address - Fax:701-857-8056
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND13901208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1465948Medicaid
ND1465948Medicaid