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General NPI Number Information
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NPI Number | 1912951419
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Entity Type | Individual
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Provider Name | A. O'TAYO LALUDE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 304 LINDBROOK ST
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City | HENDERSON
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State | NV
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Zip | 89074-5087
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Country | US
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Telephone | 502-494-1725
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Fax |
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Provider Business Mailing Address
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Address Line | 304 LINDBROOK ST
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City | HENDERSON
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State | NV
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Zip | 89074-5087
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Country | US
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Telephone | 502-494-1725
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 21661
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21661
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License Number State | KY
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