Healthcare Provider Details

I. General information

NPI: 1346225703
Provider Name (Legal Business Name): BABATUNDE O SOKAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CLINIC DR
PARIS KY
40361-2161
US

IV. Provider business mailing address

4165 JOHN ALDEN LN
LEXINGTON KY
40504-2043
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-0074
  • Fax: 859-987-0098
Mailing address:
  • Phone: 859-684-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37473
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37473
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: