MEDICARE: DR. AYODEJI O. BALOGUN 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	208M00000X	Hospitalist Physician	12122	SD

General Provider Information

NPI Number	:	1588196448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYODEJI O. BALOGUN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 W 18TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-0401
Country	:	US
Telephone Number	:	605-333-1000
Fax Number	:

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

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	06/16/2026

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