MEDICARE: ABIMBOLA Y. AWODIPE 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	207R00000X	Internal Medicine Physician	L9610	TX
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	L9610	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8P9008	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508833203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIMBOLA Y. AWODIPE MD

Provider Business Mailing Address
First Line	:	PO BOX 660599
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 AMELIA CT
Second Line	:	GERIATRIC CENTER & SENIOR SERVICES
City	:	DALLAS
State	:	TX
Zip	:	75235-7706
Country	:	US
Telephone Number	:	214-590-8369
Fax Number	:

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	11/30/2012

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