MEDICARE: DR. OMOWUMI O OLURIN M.D

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	C1005174	DE

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	:	1548265168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMOWUMI O OLURIN M.D

Provider Business Mailing Address
First Line	:	1403 N RODNEY ST
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-4218
Country	:	US
Telephone Number	:	302-654-4800
Fax Number	:	302-984-0440

Provider Business Practice Location Address
First Line	:	1403 N RODNEY ST
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-4218
Country	:	US
Telephone Number	:	302-654-4800
Fax Number	:	302-984-0440

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	04/30/2008

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