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General NPI Number Information
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NPI Number | 1972957140
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Entity Type | Individual
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Provider Name | JULIANA O ODETUNDE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 5705 LEE BLVD STE 1
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City | LEHIGH ACRES
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State | FL
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Zip | 33971-6342
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Country | US
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Telephone | 239-343-1800
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Fax | 239-343-4041
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-1800
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Fax | 239-343-4041
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MT210392
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License Number State | PA
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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 | ME139448
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License Number State | FL
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