1164757936 NPI number — DR. OLUTOYIN OGUNDIPE MD, FWACS, FMCO

Table of content: DR. OLUTOYIN OGUNDIPE MD, FWACS, FMCO (NPI 1164757936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164757936 NPI number — DR. OLUTOYIN OGUNDIPE MD, FWACS, FMCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGUNDIPE
Provider First Name:
OLUTOYIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FWACS, FMCO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164757936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5921 VISTA VERDE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28273-6976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-583-1290
Provider Business Mailing Address Fax Number:
866-262-7969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 ADEYERI CLOSE
Provider Second Line Business Practice Location Address:
OFF OPEBI STREET
Provider Business Practice Location Address City Name:
IKEJA
Provider Business Practice Location Address State Name:
LAGOS
Provider Business Practice Location Address Postal Code:
100001
Provider Business Practice Location Address Country Code:
NG
Provider Business Practice Location Address Telephone Number:
01123418922647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2897 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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