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NPI Code Detail

MEDICARE: BENEDICTA OLAMIDE UDEAGBALA D.O.

MEDICARE: BENEDICTA OLAMIDE UDEAGBALA D.O.
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 Physician34006079OH
2207Q00000XFamily Medicine PhysicianOS17771FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275633786
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENEDICTA OLAMIDE UDEAGBALA D.O.
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 941-357-7950
Fax Number :
Provider Business Practice Location Address
First Line : 1505 53RD AVE E
Second Line :
City : BRADENTON
State : FL
Zip : 34203-4249
Country : US
Telephone Number : 941-357-7950
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2006
Last Update Date : 05/17/2021

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Directions to “ BENEDICTA OLAMIDE UDEAGBALA D.O.” Practice Location

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