Provider Demographics
NPI:1366137424
Name:OGUNNEYE, YETUNDE FADEKEMI (DO)
Entity type:Individual
Prefix:
First Name:YETUNDE
Middle Name:FADEKEMI
Last Name:OGUNNEYE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:YETUNDE
Other - Middle Name:FADEKEMI
Other - Last Name:AFOLABI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE STE A601
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-3570
Mailing Address - Fax:616-391-3130
Practice Address - Street 1:100 MICHIGAN ST NE STE A601
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-3570
Practice Address - Fax:616-391-3130
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51510161712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology