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NPI Code Detail

MEDICARE: OLUFUNKE A ODETUNDE MD

MEDICARE:   OLUFUNKE A ODETUNDE  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianK1595TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18AN558OTHERBCBSTX
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38X8330OTHERBCBSTX

General Provider Information

NPI Number : 1154378958
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLUFUNKE A ODETUNDE MD
Provider Business Mailing Address
First Line : 11511 SHADOW CREEK PKWY
Second Line :
City : PEARLAND
State : TX
Zip : 77584-7298
Country : US
Telephone Number : 713-442-0000
Fax Number :
Provider Business Practice Location Address
First Line : 2515 BUSINESS CENTER DR
Second Line :
City : PEARLAND
State : TX
Zip : 77584-2294
Country : US
Telephone Number : 713-442-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2006
Last Update Date : 09/19/2024

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Directions to “ OLUFUNKE A ODETUNDE MD” Practice Location

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