=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891256616
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SULAIMON ADEBIMPE BAKRE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2019
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3019 MEDLIN DR STE 200
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76015-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-382-3435
-----------------------------------------------------
Fax | 720-794-8635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3019 MEDLIN DR STE 200
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76015-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-382-3435
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 01092136A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 036168078
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | U0301
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------