Healthcare Provider Details

I. General information

NPI: 1255621710
Provider Name (Legal Business Name): BABABO O OPANEYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3398 E MARIA DR
STEVENS POINT WI
54481-1362
US

IV. Provider business mailing address

3398 E MARIA DR
STEVENS POINT WI
54481-1362
US

V. Phone/Fax

Practice location:
  • Phone: 715-341-7441
  • Fax:
Mailing address:
  • Phone: 715-341-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number55460
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: