Basic Information
| Provider Information | |||||||||
| NPI: | 1700078706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADENIYI | ||||||||
| FirstName: | MUNIRU | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18220 STATE HIGHWAY 249 STE 490 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770704347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817370587 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3003 S LOOP W STE 204 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137969500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZN0300X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 212160005 | 05 | TX | MEDICAID | 2121600-09 | 05 | TX | MEDICAID | 212160006 | 05 | TX | MEDICAID |