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General NPI Number Information
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NPI Number | 1447336623
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Entity Type | Individual
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Provider Name | IBIKUNLE OLAYEMI KOYA MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 1205 YORK RD STE 26
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City | LUTHERVILLE
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State | MD
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Zip | 21093-6211
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Country | US
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Telephone | 410-532-1640
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Fax | 410-321-5787
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Provider Business Mailing Address
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Address Line | 1589 SULPHUR SPRING RD STE 109
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City | BALTIMORE
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State | MD
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Zip | 21227-2542
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Country | US
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Telephone | 410-536-5400
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Fax | 410-737-2168
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | D42219
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License Number State | MD
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