Provider Demographics
NPI:1912951419
Name:LALUDE, A. O'TAYO (MD)
Entity Type:Individual
Prefix:
First Name:A. O'TAYO
Middle Name:
Last Name:LALUDE
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 1:304 LINDBROOK ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5087
Mailing Address - Country:US
Mailing Address - Phone:502-494-1725
Mailing Address - Fax:
Practice Address - Street 1:304 LINDBROOK ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5087
Practice Address - Country:US
Practice Address - Phone:502-494-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21661208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64216617Medicaid
KY00546173Medicare Oscar/Certification
KY080144741Medicare PIN
KYC76054Medicare UPIN