Healthcare Provider Details

I. General information

NPI: 1750341293
Provider Name (Legal Business Name): OLUJIDE BAMIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 BEALL AVE
WOOSTER OH
44691-2342
US

IV. Provider business mailing address

PO BOX 708790
SANDY UT
84070-8790
US

V. Phone/Fax

Practice location:
  • Phone: 330-263-8326
  • Fax: 330-263-8243
Mailing address:
  • Phone: 800-846-5313
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35087398
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number059369
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number059369
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: