Provider Demographics
NPI:1982308219
Name:OPE, OMOTAYO ALADE (MD)
Entity Type:Individual
Prefix:
First Name:OMOTAYO
Middle Name:ALADE
Last Name:OPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OMOTAYO
Other - Middle Name:
Other - Last Name:OPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4725 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4603
Mailing Address - Country:US
Mailing Address - Phone:954-938-3359
Mailing Address - Fax:954-492-5790
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-938-3359
Practice Address - Fax:954-492-5790
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health