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NPI Code Detail

MEDICARE: BOLANLE ODEJIDE RRT

MEDICARE: BOLANLE ODEJIDE RRT
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
1227900000XRegistered Respiratory Therapist30008466AIN

General Provider Information

NPI Number : 1376957696
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOLANLE ODEJIDE RRT
Provider Business Mailing Address
First Line : 4247 VILLAGE TRACE DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-6229
Country : US
Telephone Number : 317-366-7583
Fax Number :
Provider Business Practice Location Address
First Line : 4247 VILLAGE TRACE DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-6229
Country : US
Telephone Number : 317-366-7583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2014
Last Update Date : 06/14/2014

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Directions to “ BOLANLE ODEJIDE RRT” Practice Location

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