Provider Demographics
NPI:1063522332
Name:OSIYEMI, OLAYEMI OLAJIDE (MD)
Entity type:Individual
Prefix:DR
First Name:OLAYEMI
Middle Name:OLAJIDE
Last Name:OSIYEMI
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 1:2580 METROCENTRE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3100
Mailing Address - Country:US
Mailing Address - Phone:561-832-6770
Mailing Address - Fax:561-832-3292
Practice Address - Street 1:2580 METROCENTRE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3100
Practice Address - Country:US
Practice Address - Phone:561-832-6770
Practice Address - Fax:561-832-3292
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72374207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258949400Medicaid
FL258949400Medicaid
FLH23486Medicare UPIN