MEDICARE: ABIOLA ADEBOLA FANIYAN MD, MPH

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
2	208000000X	Pediatrics Physician	D93456	MD

General Provider Information

NPI Number	:	1619473410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIOLA ADEBOLA FANIYAN MD, MPH

Provider Business Mailing Address
First Line	:	1 HURLEY PLZ
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48503-5902
Country	:	US
Telephone Number	:	810-262-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 E SWAN CREEK RD
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-5250
Country	:	US
Telephone Number	:	301-292-1590
Fax Number	:

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

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	06/28/2022

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