Healthcare Provider Details

I. General information

NPI: 1770337990
Provider Name (Legal Business Name): BABATUNDE LAWAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TUNDE LAWAL DO

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N 4TH ST
FLAGSTAFF AZ
86004-1816
US

IV. Provider business mailing address

2920 N 4TH ST
FLAGSTAFF AZ
86004-1816
US

V. Phone/Fax

Practice location:
  • Phone: 928-522-9400
  • Fax:
Mailing address:
  • Phone: 928-522-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: