Provider Demographics
NPI:1447352158
Name:OPEITUM, ABIOLA (MD)
Entity type:Individual
Prefix:DR
First Name:ABIOLA
Middle Name:
Last Name:OPEITUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 FOREST AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3765
Mailing Address - Country:US
Mailing Address - Phone:804-687-4793
Mailing Address - Fax:
Practice Address - Street 1:7229 FOREST AVE STE 111
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3765
Practice Address - Country:US
Practice Address - Phone:804-687-4793
Practice Address - Fax:855-618-2623
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010870812085R0001X
IN01062913A2085R0001X
VA0101236577208D00000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4856213Medicaid
MI4871541Medicaid
MII51788Medicare UPIN
MI4871541Medicaid