Healthcare Provider Details

I. General information

NPI: 1881819365
Provider Name (Legal Business Name): ENIOLA ADEYEMI OWI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W. DR. M. L. KING JR BLVD SUITE 102
TAMPA FL
33603-3453
US

IV. Provider business mailing address

607 W. DR. M. L. KING JR BLVD SUITE 102
TAMPA FL
33603-3453
US

V. Phone/Fax

Practice location:
  • Phone: 813-238-1222
  • Fax: 813-238-1214
Mailing address:
  • Phone: 813-238-1222
  • Fax: 813-238-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME 63536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: