Individual
ADISA A TIJANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9319 LBJ FWY, STE 208G, DALLAS, TX 75243-3450
(214) 575-0666
Mailing address
PO BOX 741411, DALLAS, TX 75374-1411
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0066978
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1628794
—
LA
05
—
173760301
—
TX
05
—
173760302
—
TX
05
—
173760303
—
TX
01
—
531586
BLUE CROSS BLUE SHIELD
TX
Enumeration date
02/13/2008
Last updated
02/13/2008
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