Individual provider Active NPI

Adefolarin Micheal Adeyemi, MD

  • Surgery Physician
  • Tucson, AZ
National Provider Identifier
1235983602
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
R80778 Issued in AZ
Practice address
PO Box 245058
Tucson, AZ 85724-5058
Phone
(817) 770-5841
NPI assigned
Apr 12, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X R80778 AZ
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X R80778 AZ Primary

Addresses

Primary practice location

PO Box 245058
Tucson, AZ 85724-5058

Mailing address

PO Box 245058
Tucson, AZ 85724-5058

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240716001193 AZ Order and Referring Only - General SurgeryPractitioner - General Surgery 5092250977

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R80778AZMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1235983602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 245058",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857245058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 245058",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857245058",
            "telephone_number": "817-770-5841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEYEMI",
        "first_name": "ADEFOLARIN",
        "middle_name": "MICHEAL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-12",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": "R80778",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "AZ",
            "license": "R80778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.