MEDICARE: DR. OLUWAKEMI T AWOPETU M.D.

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	207P00000X	Emergency Medicine Physician	MD441252	PA
2	207P00000X	Emergency Medicine Physician	4301105498	MI
3	207P00000X	Emergency Medicine Physician	MT193757	PA
4	207P00000X	Emergency Medicine Physician	25MA09247500	NJ

General Provider Information

NPI Number	:	1316107808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLUWAKEMI T AWOPETU M.D.

Provider Business Mailing Address
First Line	:	3401 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5103
Country	:	US
Telephone Number	:	215-707-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 W ONTARIO ST
Second Line	:	10TH FLOOR, JONES HALL
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5220
Country	:	US
Telephone Number	:	215-707-7500
Fax Number	:

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

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	03/21/2024

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