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NPI Code Detail

MEDICARE: DR. AJUMOBI CHARLES AGU M.D.

MEDICARE: DR. AJUMOBI CHARLES AGU 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
1207R00000XInternal Medicine Physician8857NV

General Provider Information

NPI Number : 1336453927
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AJUMOBI CHARLES AGU M.D.
Provider Business Mailing Address
First Line : 2235 E FLAMINGO RD STE 128
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5189
Country : US
Telephone Number : 725-204-5658
Fax Number : 725-204-9077
Provider Business Practice Location Address
First Line : 2235 E FLAMINGO RD STE 128
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5189
Country : US
Telephone Number : 725-204-5658
Fax Number : 725-204-9077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2010
Last Update Date : 07/21/2022

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