MEDICARE: OLUWATOYOSI OLUMIDE

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
1	2083B0002X	Obesity Medicine (Preventive Medicine) Physician	1050077	TX
2	207Q00000X	Family Medicine Physician	1050077	TX

General Provider Information

NPI Number	:	1174291926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWATOYOSI OLUMIDE

Provider Business Mailing Address
First Line	:	11355 RICHMOND AVE APT 1721
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-7662
Country	:	US
Telephone Number	:	512-785-3151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 ARBOR ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-6026
Country	:	US
Telephone Number	:	833-430-4807
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2021
Last Update Date	:	09/04/2021

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Directions to “ OLUWATOYOSI OLUMIDE ” Practice Location

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