MEDICARE: KOLAPO DAIRO

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	390200000X	Student in an Organized Health Care Education/Training Program	4351057146	MI

General Provider Information

NPI Number	:	1952106742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOLAPO DAIRO

Provider Business Mailing Address
First Line	:	3990 JOHN R ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 SAINT ANTOINE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2153
Country	:	US
Telephone Number	:	313-577-0804
Fax Number	:

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

Provider Enumeration Date	:	02/15/2025
Last Update Date	:	06/15/2026

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Directions to “ KOLAPO DAIRO ” Practice Location

Language	Start Address	Practice Location

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