Provider Demographics
NPI:1982950937
Name:ADEPOJU, OLUWAROTIMI A (MD)
Entity type:Individual
Prefix:
First Name:OLUWAROTIMI
Middle Name:A
Last Name:ADEPOJU
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 1:1230 FLORIDA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2378
Mailing Address - Country:US
Mailing Address - Phone:813-775-5120
Mailing Address - Fax:
Practice Address - Street 1:2507A OLD BRANDON RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4604
Practice Address - Country:US
Practice Address - Phone:601-531-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35130417208000000X, 208M00000X
TXQ6804208000000X
MS272172080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03637292Medicaid
OH0241843Medicaid