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General NPI Number Information
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NPI Number | 1508048745
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Entity Type | Organization
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Legal Business Name | HEAL MEDICAL GROUP LLC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 200 BANNING ST SUITE #300
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City | DOVER
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State | DE
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Zip | 19904-3485
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Country | US
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Telephone | 302-741-0204
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Fax | 302-674-5874
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Provider Business Mailing Address
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Address Line | 200 BANNING ST SUITE 300
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City | DOVER
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State | DE
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Zip | 19904-3485
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Country | US
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Telephone | 302-367-5808
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Fax | 302-674-5874
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AYOOLA AYOBANJI AYOOLA
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Credential | MD
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Telephone | 302-741-0204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C1-0007939
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License Number State | DE
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