MEDICARE: BOSEDE O ADETUNJI

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	164W00000X	Licensed Practical Nurse	112143	OH

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	:	1356372148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOSEDE O ADETUNJI

Provider Business Mailing Address
First Line	:	15738 BOONRIDGE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3732
Country	:	US
Telephone Number	:	614-596-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	15738 BOONRIDGE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053
Country	:	US
Telephone Number	:	614-596-4626
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/02/2018

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Directions to “ BOSEDE O ADETUNJI ” Practice Location

Language	Start Address	Practice Location

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