MEDICARE: DR. BABAJIDE ADENIYI OGUNLANA D.P.M

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	213E00000X	Podiatrist	1699	TX
2	213ER0200X	Radiology Podiatrist	1699	TX
3	213ES0000X	Sports Medicine Podiatrist	1699	TX
4	213ES0131X	Foot Surgery Podiatrist	1699	TX
5	213ES0103X	Foot & Ankle Surgery Podiatrist	1699	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0074ME	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1891793071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BABAJIDE ADENIYI OGUNLANA D.P.M

Provider Business Mailing Address
First Line	:	4502 RIVERSTONE BLVD STE 1403
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5206
Country	:	US
Telephone Number	:	281-778-5560
Fax Number	:	281-677-4145

Provider Business Practice Location Address
First Line	:	4502 RIVERSTONE BLVD
Second Line	:	STE 1403
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5206
Country	:	US
Telephone Number	:	281-778-5560
Fax Number	:	281-677-4145

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/18/2024

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Directions to “ DR. BABAJIDE ADENIYI OGUNLANA D.P.M” Practice Location

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