Healthcare Provider Details

I. General information

NPI: 1700181062
Provider Name (Legal Business Name): ABIODUN KUTEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 W AIRPORT BLVD STE 8
STAFFORD TX
77477-3342
US

IV. Provider business mailing address

10315 W AIRPORT BLVD STE 8
STAFFORD TX
77477-3342
US

V. Phone/Fax

Practice location:
  • Phone: 281-495-9838
  • Fax: 281-495-9803
Mailing address:
  • Phone: 281-495-9838
  • Fax: 281-495-9803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: