Provider Demographics
NPI:1992803498
Name:ADEDOKUN, MUYIWA (MD)
Entity type:Individual
Prefix:DR
First Name:MUYIWA
Middle Name:
Last Name:ADEDOKUN
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 1:1005 DR DB TODD JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3501
Mailing Address - Country:US
Mailing Address - Phone:615-327-5944
Mailing Address - Fax:615-327-5597
Practice Address - Street 1:1130 DOW ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2486
Practice Address - Country:US
Practice Address - Phone:615-867-2700
Practice Address - Fax:615-867-2757
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31108208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF70848Medicare UPIN
TN3854189Medicare ID - Type Unspecified