Healthcare Provider Details

I. General information

NPI: 1457654147
Provider Name (Legal Business Name): MR. EMMANUEL OGUNDEINDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 MARTINS WAY APT D
ORLANDO FL
32808-1141
US

IV. Provider business mailing address

4430 MARTINS WAY APT D
ORLANDO FL
32808-1141
US

V. Phone/Fax

Practice location:
  • Phone: 407-437-6937
  • Fax: 407-574-3595
Mailing address:
  • Phone: 407-437-6937
  • Fax: 407-574-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number0253220171120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: