Provider Demographics
NPI:1841447992
Name:ADERINTO, OLUMAYOWA ADEFUNKE (MD)
Entity type:Individual
Prefix:DR
First Name:OLUMAYOWA
Middle Name:ADEFUNKE
Last Name:ADERINTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAYOWA
Other - Middle Name:ADEFUNKE
Other - Last Name:ADEEKUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4502 RIVERSTONE BLVD
Mailing Address - Street 2:STE 1403
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5210
Mailing Address - Country:US
Mailing Address - Phone:713-239-4249
Mailing Address - Fax:281-978-4341
Practice Address - Street 1:1401 ST. JOSEPH PARKWAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8301
Practice Address - Country:US
Practice Address - Phone:713-756-8537
Practice Address - Fax:713-756-8538
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46518207R00000X
TXN8749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB132044Medicare PIN