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General NPI Number Information
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NPI Number | 1396961967
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Entity Type | Individual
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Provider Name | OSAWARU JUDE OMORUYI M.D
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Gender | Male
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 2202 BUECHEL AVE STE 105
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City | LOUISVILLE
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State | KY
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Zip | 40218-2672
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Country | US
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Telephone | 502-367-3360
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Fax | 502-367-3365
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Provider Business Mailing Address
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Address Line | 2202 BUECHEL AVE STE 105
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City | LOUISVILLE
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State | KY
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Zip | 40218-2672
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Country | US
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Telephone | 502-456-0494
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Fax | 502-456-0496
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.088666
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 01066757A
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License Number State | IN
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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 | 42023
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License Number State | KY
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