Healthcare Provider Details

I. General information

NPI: 1972976496
Provider Name (Legal Business Name): OBISESAN TRANSITIONS MHT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1515 HERITAGE DR
MCKINNEY TX
75069-3256
US

IV. Provider business mailing address

2548 CYPRESS OAK LN
GASTONIA NC
28056-0016
US

V. Phone/Fax

Practice location:
  • Phone: 844-633-4663
  • Fax:
Mailing address:
  • Phone: 616-813-5108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35826
License Number StateSC

VIII. Authorized Official

Name: DR. BABAJIDE A OBISESAN
Title or Position: OWNER
Credential: M.D
Phone: 616-813-5108