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General NPI Number Information
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NPI Number | 1033759089
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Entity Type | Individual
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Provider Name | KAYODE MOSHOOD BALOGUN MD
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Gender | Male
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 7236 STATE ROAD 52 STE 13
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City | HUDSON
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State | FL
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Zip | 34667-6749
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Country | US
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Telephone | 727-233-6084
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Fax |
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Provider Business Mailing Address
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Address Line | 7236 STATE ROAD 52 STE 13
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City | HUDSON
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State | FL
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Zip | 34667-6749
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Country | US
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Telephone | 727-233-6084
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Fax | 727-255-5128
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 58796
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1417
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ACN1417
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License Number State | FL
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