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General NPI Number Information
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NPI Number | 1770683732
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Entity Type | Individual
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Provider Name | ABIMBOLA A ODUKOYA M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 3741 ROME DR SUITE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-4490
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Country | US
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Telephone | 765-607-6160
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Fax | 765-607-6161
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Provider Business Mailing Address
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Address Line | 3741 ROME DR SUITE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-4490
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Country | US
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Telephone | 765-607-6160
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Fax | 765-607-6161
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 61002723
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01062400A
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License Number State | IN
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