Healthcare Provider Details

I. General information

NPI: 1073780698
Provider Name (Legal Business Name): SUNDAY O. BANKOLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 N 16TH ST SUITE 425
PHOENIX AZ
85020-4492
US

IV. Provider business mailing address

7720 N 16TH ST SUITE 425
PHOENIX AZ
85020-4492
US

V. Phone/Fax

Practice location:
  • Phone: 602-476-0800
  • Fax: 602-476-8959
Mailing address:
  • Phone: 602-476-0800
  • Fax: 602-476-8959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43694
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: