MEDICARE: OLABIMPE ODETUNMIBI

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	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1063834349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLABIMPE ODETUNMIBI

Provider Business Mailing Address
First Line	:	5801 PRESTON OAKS RD APT 102
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-8713
Country	:	US
Telephone Number	:	214-694-7698
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 PRESTON OAKS RD APT 102
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-8713
Country	:	US
Telephone Number	:	214-694-7698
Fax Number	:

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

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/06/2014

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Directions to “ OLABIMPE ODETUNMIBI ” Practice Location

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