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General NPI Number Information
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NPI Number | 1619806296
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Entity Type | Individual
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Provider Name | BABATUNDE SAMUEL OGUNFOWOKAN
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Gender | Male
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Dates
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Enumeration Date | 05/18/2026
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Last Update Date | 05/18/2026
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Provider Practice Location Address
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Address Line | 200 UNIVERSITY PARK DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-3649
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Country | US
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Telephone | 618-650-3957
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Fax |
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Provider Business Mailing Address
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Address Line | 3140 IMPALA TRL
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City | FRISCO
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State | TX
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Zip | 75034-6219
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Country | US
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Telephone | 404-587-7347
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Fax | 404-587-7347
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.606478
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License Number State | IL
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