Provider Demographics
NPI:1114507456
Name:OYEDELE, TOLUWANIMI A (MD)
Entity type:Individual
Prefix:
First Name:TOLUWANIMI
Middle Name:A
Last Name:OYEDELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TOLUWANIMI
Other - Middle Name:A
Other - Last Name:TOLA-ADELANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5177 MCCARTY LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-8764
Mailing Address - Country:US
Mailing Address - Phone:765-838-7101
Mailing Address - Fax:
Practice Address - Street 1:810 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-8201
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:574-583-9502
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01094062A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN815500684OtherMEDICARE PTAN