Healthcare Provider Details

I. General information

NPI: 1407343551
Provider Name (Legal Business Name): TOLULOPE FAMUYIRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOLULOPE AKINTIDE

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 GROOM RD
BAKER LA
70714-4364
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 225-614-9065
  • Fax: 855-583-3594
Mailing address:
  • Phone: 844-630-0700
  • Fax: 877-374-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number330938
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number288037
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number0101271156
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: