Provider Demographics
NPI:1437211828
Name:ADISA-OBAYAN, ABIOLA DIANNE (MD)
Entity type:Individual
Prefix:DR
First Name:ABIOLA
Middle Name:DIANNE
Last Name:ADISA-OBAYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ABIOLA
Other - Middle Name:DIANNE
Other - Last Name:OBAYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26333 SOUTHFIELD RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4574
Mailing Address - Country:US
Mailing Address - Phone:248-331-1900
Mailing Address - Fax:
Practice Address - Street 1:26333 SOUTHFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4574
Practice Address - Country:US
Practice Address - Phone:248-331-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAA0623972081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M73800Medicare PIN
MI0N95840Medicare PIN
MI0N95840001Medicare PIN
MIG44111Medicare UPIN