MEDICARE: DR. OLAYIWOLA C OLAGBEGI M.D.

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	207RG0100X	Gastroenterology Physician	036099505	IL
2	207RG0100X	Gastroenterology Physician	114046	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100011347	OTHER	MO	MEDICARE RAILROAD

Other Identifiers

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

General Provider Information

NPI Number	:	1912011255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLAYIWOLA C OLAGBEGI M.D.

Provider Business Mailing Address
First Line	:	11155 DUNN RD STE 309E
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6111
Country	:	US
Telephone Number	:	314-953-8799
Fax Number	:

Provider Business Practice Location Address
First Line	:	11155 DUNN RD STE 309E
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6111
Country	:	US
Telephone Number	:	314-953-8799
Fax Number	:

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	01/11/2023

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Directions to “ DR. OLAYIWOLA C OLAGBEGI M.D.” Practice Location

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