Healthcare Provider Details

I. General information

NPI: 1669813234
Provider Name (Legal Business Name): OPEYEMI ABIODUN AWE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

1660 S STAPLES ST STE 150
CORPUS CHRISTI TX
78404-3156
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8776
  • Fax: 317-963-5285
Mailing address:
  • Phone: 361-800-8155
  • Fax: 361-882-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberQ7009
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01072943A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01072943A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: