MEDICARE: MR. TAIWO FAWEHINMI

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)	1034	TX

General Provider Information

NPI Number	:	1235890609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TAIWO FAWEHINMI

Provider Business Mailing Address
First Line	:	3950 ASHBURNHAM DR APT 91
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5942
Country	:	US
Telephone Number	:	713-725-5835
Fax Number	:	281-494-0351

Provider Business Practice Location Address
First Line	:	3950 ASHBURNHAM DR APT 91
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-5942
Country	:	US
Telephone Number	:	713-725-5835
Fax Number	:	281-494-0351

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

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/06/2022

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