MEDICARE: OMONIYI ADENIKE OGUNDIPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1063044055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMONIYI ADENIKE OGUNDIPE

Provider Business Mailing Address
First Line	:	3003 SEAGLER RD APT 4112
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3076
Country	:	US
Telephone Number	:	404-910-8263
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 SEAGLER RD APT 4112
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-3076
Country	:	US
Telephone Number	:	404-910-8263
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	02/07/2020

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