Provider Demographics
NPI:1174525638
Name:ALADE, OLATUNDE ABIODUN
Entity type:Individual
Prefix:MR
First Name:OLATUNDE
Middle Name:ABIODUN
Last Name:ALADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41069 DEQUINDRE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6730
Mailing Address - Country:US
Mailing Address - Phone:248-733-5334
Mailing Address - Fax:
Practice Address - Street 1:41069 DEQUINDRE RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-6730
Practice Address - Country:US
Practice Address - Phone:248-733-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4429125Medicaid
MI4429125Medicaid