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General NPI Number Information
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NPI Number | 1952769903
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Entity Type | Organization
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Legal Business Name | OLUPONA FOOT AND ANKLE, LLC
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Dates
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Enumeration Date | 02/05/2016
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 2601 SW 37TH AVE STE 904
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City | MIAMI
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State | FL
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Zip | 33133-2751
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Country | US
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Telephone | 202-321-8812
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 SW 37TH AVE STE 904
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City | MIAMI
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State | FL
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Zip | 33133-2751
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Country | US
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Telephone | 202-321-8812
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BAMIDELE OLUPONA
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Credential | D.P.M.
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Telephone | 202-321-8812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3757
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License Number State | FL
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