MEDICARE: MICHAEL SOLEDAYO FAGBAMIYE CEO

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	3747A0650X	Attendant Care Provider	25-018973-1	IN
2	253Z00000X	In Home Supportive Care Agency	25-018973-1	IN

General Provider Information

NPI Number	:	1457226276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SOLEDAYO FAGBAMIYE CEO

Provider Business Mailing Address
First Line	:	6025 PEREGRINE BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-1504
Country	:	US
Telephone Number	:	317-652-6420
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 PEREGRINE BLVD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-1504
Country	:	US
Telephone Number	:	317-652-6420
Fax Number	:

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

Provider Enumeration Date	:	10/09/2025
Last Update Date	:	10/09/2025

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