MEDICARE: DR. OLATUNDE IDOWU MD

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	208M00000X	Hospitalist Physician	057374	GA
2	207R00000X	Internal Medicine Physician	057374	GA

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	:	1417951369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLATUNDE IDOWU MD

Provider Business Mailing Address
First Line	:	3950 AUSTELL RD
Second Line	:	BOX 22
City	:	AUSTELL
State	:	GA
Zip	:	30106-1121
Country	:	US
Telephone Number	:	770-732-4022
Fax Number	:	770-732-4023

Provider Business Practice Location Address
First Line	:	3950 AUSTELL RD
Second Line	:	BOX 22
City	:	AUSTELL
State	:	GA
Zip	:	30106-1121
Country	:	US
Telephone Number	:	770-732-4022
Fax Number	:	770-732-4023

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/09/2019

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