Provider Demographics
NPI:1245511500
Name:ADEOGUN, OYINKANSOLA MARY (MD)
Entity type:Individual
Prefix:DR
First Name:OYINKANSOLA
Middle Name:MARY
Last Name:ADEOGUN
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 1:11550 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2100
Mailing Address - Country:US
Mailing Address - Phone:407-384-0080
Mailing Address - Fax:
Practice Address - Street 1:11550 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2100
Practice Address - Country:US
Practice Address - Phone:407-384-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117013207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine