Provider Demographics
NPI:1902086937
Name:ADEDEJI, ADEKUNLE ADEDAYO (MD)
Entity Type:Individual
Prefix:MR
First Name:ADEKUNLE
Middle Name:ADEDAYO
Last Name:ADEDEJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8623 N LOOP DR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4520
Mailing Address - Country:US
Mailing Address - Phone:915-881-4155
Mailing Address - Fax:915-881-4172
Practice Address - Street 1:8623 N LOOP DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4520
Practice Address - Country:US
Practice Address - Phone:915-881-4155
Practice Address - Fax:915-881-4172
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3416207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB116628OtherWELLMED MEDICARE
TX2100976-03OtherWELLMED MEDICAID
TXTXB158260OtherMEDICARE PTAN