Healthcare Provider Details

I. General information

NPI: 1215006069
Provider Name (Legal Business Name): DR. SESI OGUNBI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E SOUTH BLVD SUITE 410
MONTGOMERY AL
36116-2001
US

IV. Provider business mailing address

2055 E SOUTH BLVD SUITE 410
MONTGOMERY AL
36116-2001
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-6882
  • Fax: 334-288-2334
Mailing address:
  • Phone: 334-288-6882
  • Fax: 334-288-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number16380
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number16380
License Number StateAL

VIII. Authorized Official

Name: DR. SESI OLUFUNMILAYO DOSUNMU-OGUNBI
Title or Position: OWNER
Credential: M.D.
Phone: 334-288-6882