Basic Information
| Provider Information | |||||||||
| NPI: | 1134167711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADEPITAN | ||||||||
| FirstName: | OLAYINKA | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2419 COIT RD STE B | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750753731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722949555 | ||||||||
| FaxNumber: | 8888374248 | ||||||||
| Practice Location | |||||||||
| Address1: | 2419 COIT RD STE B | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750753731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727155000 | ||||||||
| FaxNumber: | 9727159976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4301080680 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | L9987 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | L9987 | TX | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4625083-10 | 05 | MI | MEDICAID | 190871704 | 05 | TX | MEDICAID | BCBS | 01 | TX | 8EH302 | OTHER | P00146883 | 01 | MI | RAILROAD MEDICARE | OTHER |