Healthcare Provider Details

I. General information

NPI: 1184908964
Provider Name (Legal Business Name): MR. MUSIBAU ADEYEMI IPAYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 N CLASSEN BLVD #159
OKLAHOMA CITY OK
73118-4627
US

IV. Provider business mailing address

4801 N CLASSEN BLVD #159
OKLAHOMA CITY OK
73118-4627
US

V. Phone/Fax

Practice location:
  • Phone: 405-607-6670
  • Fax: 405-607-6671
Mailing address:
  • Phone: 405-607-6670
  • Fax: 405-607-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: