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General NPI Number Information
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NPI Number | 1790118875
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Entity Type | Individual
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Provider Name | KAYODE ODUTAYO M.D
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Gender | Male
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 1650 GRAND CONCOURSE
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City | BRONX
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State | NY
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Zip | 10457-7679
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Country | US
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Telephone | 718-992-7669
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Fax |
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Provider Business Mailing Address
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Address Line | 150 MOTOR PKWY STE 4012324
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City | HAUPPAUGE
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State | NY
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Zip | 11788-5145
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Country | US
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Telephone | 631-209-5369
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 296259
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 296259
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License Number State | NY
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