Provider Demographics
NPI:1285898940
Name:ABDUL, OLUMUYIWA ADEGBENGA (MD)
Entity type:Individual
Prefix:DR
First Name:OLUMUYIWA
Middle Name:ADEGBENGA
Last Name:ABDUL
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 1:2100 PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1419
Mailing Address - Country:US
Mailing Address - Phone:216-255-5116
Mailing Address - Fax:
Practice Address - Street 1:2100 PRESTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-1419
Practice Address - Country:US
Practice Address - Phone:216-255-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3214092084P0800X
TXP19542084P0800X
390200000X
OH35.0958552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program