Healthcare Provider Details

I. General information

NPI: 1609005453
Provider Name (Legal Business Name): OLUWAKEMI FAGBAMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 AVENUE B
SCOTTSBLUFF NE
69361-4602
US

IV. Provider business mailing address

3948 LEGACY DR # 264
PLANO TX
75023-8300
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3711
  • Fax:
Mailing address:
  • Phone: 610-750-5207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM-16197
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ0043
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: