MEDICARE: FOLUSO OGUNSILE 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
1	207RH0003X	Hematology & Oncology Physician	38632	AL
2	207RH0000X	Hematology (Internal Medicine) Physician	ME159177	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1619234242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FOLUSO OGUNSILE MD

Provider Business Mailing Address
First Line	:	2900 CORPORATE WAY
Second Line	:	DOOR D
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3925
Country	:	US
Telephone Number	:	954-276-5685
Fax Number	:	954-985-7074

Provider Business Practice Location Address
First Line	:	3700 JOHNSON ST
Second Line	:	SUITE B
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3302
Country	:	US
Telephone Number	:	954-265-1400
Fax Number	:	954-276-0386

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

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	12/15/2022

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