Healthcare Provider Details

I. General information

NPI: 1659367167
Provider Name (Legal Business Name): ABIODUN SOSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD NORTH BROWARD ED
POMPANO BEACH FL
33064-3502
US

IV. Provider business mailing address

10262 BUENA VENTURA DR
BOCA RATON FL
33498-6766
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME72533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: