MEDICARE: DR. BABATUNDE OLUTADE MD

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	207RN0300X	Nephrology Physician	015731	MS

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	:	1316050750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BABATUNDE OLUTADE MD

Provider Business Mailing Address
First Line	:	5903 RIDGEWOOD RD
Second Line	:	SUITE 340
City	:	JACKSON
State	:	MS
Zip	:	39211-3700
Country	:	US
Telephone Number	:	601-899-3340
Fax Number	:	601-899-3343

Provider Business Practice Location Address
First Line	:	5903 RIDGEWOOD RD
Second Line	:	SUITE 340
City	:	JACKSON
State	:	MS
Zip	:	39211-3700
Country	:	US
Telephone Number	:	601-899-3340
Fax Number	:	601-899-3343

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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