Basic Information
| Provider Information | |||||||||
| NPI: | 1104898600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MABADEJE | ||||||||
| FirstName: | ADETAYO | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3945 | ||||||||
| Address2: | DEPT 841 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772533945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813588114 | ||||||||
| FaxNumber: | 2813580609 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 SPENCER HWY | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775041202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133592000 | ||||||||
| FaxNumber: | 7133591004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 01/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 0101235560 | VA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207L00000X | M5824 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P00416927 | 01 | TX | RAILROAD MEDICARE | OTHER | 1003493 | 01 | VA | VA PREMIER | OTHER | 100988 | 01 | VA | ANTHEM | OTHER | 8AA961 | 01 | TX | BCSB | OTHER | 230920 | 01 | VA | SOUTHERN HEALTH | OTHER | 8W7376 | 01 | TX | BLUE CROSS PROVIDER ID | OTHER | 2224992 | 01 | VA | FIRST HEALTH | OTHER | 73866 | 01 | VA | OPTIMA | OTHER | 188438902 | 05 | TX | MEDICAID | 188438903 | 05 | TX | MEDICAID | P00091266 | 01 | VA | PALMETTO | OTHER | P00817171 | 01 | TX | RR MCR | OTHER | 010034931 | 05 | VA | MEDICAID | 1884389 01 | 05 | TX | MEDICAID | 7486021 | 01 | VA | CIGNA | OTHER |