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NPI Code Detail

MEDICARE: DR. FOLUSO A FAKOREDE MD

MEDICARE: DR. FOLUSO A FAKOREDE 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
1207RI0011XInterventional Cardiology Physician23725MS

General Provider Information

NPI Number : 1679730329
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FOLUSO A FAKOREDE MD
Provider Business Mailing Address
First Line : 800 N PEARMAN AVE
Second Line :
City : CLEVELAND
State : MS
Zip : 38732-3502
Country : US
Telephone Number : 888-757-0838
Fax Number : 888-757-1835
Provider Business Practice Location Address
First Line : 800 N PEARMAN AVE
Second Line :
City : CLEVELAND
State : MS
Zip : 38732-3502
Country : US
Telephone Number : 888-757-0838
Fax Number : 888-757-1835
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2008
Last Update Date : 04/13/2020

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