Healthcare Provider Details

I. General information

NPI: 1760504419
Provider Name (Legal Business Name): OLUDAPO SOREMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 S JOHN YOUNG PKWY
ORLANDO FL
32839-3716
US

IV. Provider business mailing address

5900 S JOHN YOUNG PKWY
ORLANDO FL
32839-3716
US

V. Phone/Fax

Practice location:
  • Phone: 407-398-6470
  • Fax: 407-894-6872
Mailing address:
  • Phone: 407-398-6470
  • Fax: 407-894-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME73889
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME73889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: