Provider Demographics
NPI:1811197353
Name:ADEDAYO, OLAYINKA A (MD)
Entity type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:A
Last Name:ADEDAYO
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 1:1803 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3728
Mailing Address - Country:US
Mailing Address - Phone:563-327-2000
Mailing Address - Fax:563-327-2045
Practice Address - Street 1:500 W RIVER DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1014
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-336-3044
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36118910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA99809OtherBC/BS OF IA INDIVIDUAL
1710971486OtherMOLINE CLINIC NPI
421060724OtherTRINITY PHO
IL421060724003Medicaid
IL8122859OtherBC/BS OF IL
IA0568998Medicaid
IL421060724001OtherTRICARE INDIVIDUALS
14-1942OtherMEDICARE FQHC # UGS
IL254585OtherMIDLANDS CHOICE INDIVIDUA
IL8122859OtherBC/BS OF IL