Healthcare Provider Details

I. General information

NPI: 1952976292
Provider Name (Legal Business Name): MOFOLUWASO IBIWOYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W POPLAR AVE
COLLIERVILLE TN
38017-0601
US

IV. Provider business mailing address

1500 W POPLAR AVE
COLLIERVILLE TN
38017-0601
US

V. Phone/Fax

Practice location:
  • Phone: 901-861-9000
  • Fax:
Mailing address:
  • Phone: 901-861-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number77785
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: