MEDICARE: ADE OSIBAMIRO MD INC

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	208D00000X	General Practice Physician	A64972	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073547220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADE OSIBAMIRO MD INC

Provider Business Mailing Address
First Line	:	2637 E CARSON ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90810-1508
Country	:	US
Telephone Number	:	310-847-1321
Fax Number	:	310-847-1825

Provider Business Practice Location Address
First Line	:	2637 E CARSON ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90810-1508
Country	:	US
Telephone Number	:	310-847-1321
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. THOMAS PETIT
Credential	:	MD
Telephone Number	:	310-847-1321

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/28/2026

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Directions to “ADE OSIBAMIRO MD INC ” Practice Location

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