Healthcare Provider Details

I. General information

NPI: 1366734170
Provider Name (Legal Business Name): SOLOMON BABAJIDE OLABIYI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HARTFORD ST
HOULTON ME
04730-1844
US

IV. Provider business mailing address

22 HARTFORD ST
HOULTON ME
04730-1844
US

V. Phone/Fax

Practice location:
  • Phone: 207-532-4068
  • Fax: 207-532-9426
Mailing address:
  • Phone: 207-532-4068
  • Fax: 207-532-9426

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 State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD20407
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: