Healthcare Provider Details

I. General information

NPI: 1043951577
Provider Name (Legal Business Name): TAJUDEEN OLAPOSI BASIRU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 216TH ST
CUTLER BAY FL
33190-1003
US

IV. Provider business mailing address

2909 ADDISON ST
BATON ROUGE LA
70805-6985
US

V. Phone/Fax

Practice location:
  • Phone: 305-252-5899
  • Fax:
Mailing address:
  • Phone: 979-422-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME171846
License Number StateFL
# 2
Primary TaxonomyN
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: