MEDICARE: OLADIPO EMMANUEL ODUSOLA

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	390200000X	Student in an Organized Health Care Education/Training Program	39	PA

General Provider Information

NPI Number	:	1326472564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLADIPO EMMANUEL ODUSOLA

Provider Business Mailing Address
First Line	:	3045 PYRAMID AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-2855
Country	:	US
Telephone Number	:	412-251-7108
Fax Number	:

Provider Business Practice Location Address
First Line	:	3045 PYRAMID AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-2855
Country	:	US
Telephone Number	:	412-251-7108
Fax Number	:

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

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	08/23/2013

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