Provider Demographics
NPI:1447348982
Name:ALLI, ADEREMI B (MD)
Entity type:Individual
Prefix:
First Name:ADEREMI
Middle Name:B
Last Name:ALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:STE 6250
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-8294
Mailing Address - Fax:937-208-8388
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE 6250
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-8294
Practice Address - Fax:937-208-8388
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084148207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000505108OtherANTHEM BCBS
OH2690833Medicaid
001908654OtherMOUNTAIN STATE BCBS
WV3810006753Medicaid
001908654OtherMOUNTAIN STATE BCBS
OHH035980Medicare PIN