Provider Demographics
NPI:1700064805
Name:ABIODUN O DUROJAIYE
Entity Type:Organization
Organization Name:ABIODUN O DUROJAIYE
Other - Org Name:CAMAD MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:O
Authorized Official - Last Name:DUROJAIYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-340-3326
Mailing Address - Street 1:11020 AUDELIA RD
Mailing Address - Street 2:STE B103
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-0000
Mailing Address - Country:US
Mailing Address - Phone:214-340-3326
Mailing Address - Fax:214-340-5116
Practice Address - Street 1:11020 AUDELIA RD
Practice Address - Street 2:STE B103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-0000
Practice Address - Country:US
Practice Address - Phone:214-340-3326
Practice Address - Fax:214-340-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0066979332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171364601Medicaid
TX531468OtherBLUE CROSS BLUE SHIELD
=========OtherUNITED HEALTHCARE
IL=========OtherUNICARE
TX=========OtherPACIFICARE
KY=========OtherAETNA INSURANCE
TN=========OtherCIGNA HEALTHCARE
KY=========OtherHUMANA HEALTHCARE
WI=========OtherDALLAS GENERAL LIFE INS
IL=========OtherUNICARE
WI=========OtherDALLAS GENERAL LIFE INS