MEDICARE: DR. MUKOSOLU FLORENCE OBI 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1487232047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUKOSOLU FLORENCE OBI MD

Provider Business Mailing Address
First Line	:	1562 E 98TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5514
Country	:	US
Telephone Number	:	504-327-8237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1562 E 98TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5514
Country	:	US
Telephone Number	:	504-327-8237
Fax Number	:

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

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	04/01/2021

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