Provider Demographics
NPI:1316090129
Name:ADETUTU, TAIWO EBUN-OLU (MD)
Entity type:Individual
Prefix:DR
First Name:TAIWO
Middle Name:EBUN-OLU
Last Name:ADETUTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAIWO
Other - Middle Name:EBUN-OLU
Other - Last Name:DOSUNMU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:12919 PARTRIDGE BEND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7389
Mailing Address - Country:US
Mailing Address - Phone:512-918-1986
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-285-6228
Practice Address - Fax:254-285-6193
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6059208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics