Provider Demographics
NPI:1770986465
Name:ALLI, OPEYEMI (MD)
Entity type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:
Last Name:ALLI
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 1:2633 COMMONS BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3827
Mailing Address - Country:US
Mailing Address - Phone:937-986-1862
Mailing Address - Fax:937-702-9041
Practice Address - Street 1:2633 COMMONS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3827
Practice Address - Country:US
Practice Address - Phone:937-429-0607
Practice Address - Fax:937-702-9041
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35130899208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0231367Medicaid