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NPI Code Detail

MEDICARE: MR. OLA ADEBAYO BALOGUN

MEDICARE:  MR. OLA ADEBAYO BALOGUN
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
1332B00000XDurable Medical Equipment & Medical SuppliesNC

General Provider Information

NPI Number : 1184821704
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OLA ADEBAYO BALOGUN
Provider Business Mailing Address
First Line : 2116 SPRING FOREST RD
Second Line :
City : RALEIGH
State : NC
Zip : 27615-7533
Country : US
Telephone Number : 919-271-0517
Fax Number : 800-608-8907
Provider Business Practice Location Address
First Line : 1307 E MILLBROOK RD STE C106
Second Line :
City : RALEIGH
State : NC
Zip : 27609-5476
Country : US
Telephone Number : 919-271-0517
Fax Number : 800-608-8907
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 07/08/2007

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Directions to “ MR. OLA ADEBAYO BALOGUN ” Practice Location

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