Individual
ADEOLA A. AMUSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9202 ELAM RD, SOUTHEAST DALLAS HEALTH CENTER, DALLAS, TX 75217-4151
(214) 266-1600
(214) 266-1790
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L1515
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148738105
—
TX
05
—
148738106
—
TX
05
—
148738108
—
TX
05
—
148738109
—
TX
05
—
148738110
—
TX
05
—
148738111
—
TX
05
—
148738113
—
TX
05
—
148738114
—
TX
05
—
148738115
—
TX
05
—
148738116
—
TX
05
—
148738117
—
TX
05
—
148738119
—
TX
01
—
8U3653
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/06/2005
Last updated
02/20/2014
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