Healthcare Provider Details

I. General information

NPI: 1245896224
Provider Name (Legal Business Name): MOBOLANLE ASOPE ELDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 BEVINS LN STE F
GEORGETOWN KY
40324-8534
US

IV. Provider business mailing address

196 BEVINS LN STE F
GEORGETOWN KY
40324-8534
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-2818
  • Fax: 502-863-2764
Mailing address:
  • Phone: 502-863-2818
  • Fax: 502-863-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number56363
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: