Provider Demographics
NPI:1841588068
Name:ADEYEMO, TOLULOPE (MD)
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:ADEYEMO
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 1:6841 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4418
Mailing Address - Country:US
Mailing Address - Phone:904-862-2175
Mailing Address - Fax:904-245-1940
Practice Address - Street 1:6841 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4418
Practice Address - Country:US
Practice Address - Phone:904-862-2175
Practice Address - Fax:904-245-1940
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHU996ZMedicare PIN