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1679744676

NPI Code Detail

MEDICARE: BABATUNDE ADEBOLA OTINWA D.O.

MEDICARE: BABATUNDE ADEBOLA OTINWA D.O.

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	207Q00000X	Family Medicine Physician	N5306	TX
2	207P00000X	Emergency Medicine Physician	N5306	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1679744676	OTHER	TX	TRICARE SOUTH
2	8DH241	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8DL678	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1679744676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABATUNDE ADEBOLA OTINWA D.O.

Provider Business Mailing Address
First Line	:	6302 FAIRBANKS N HOUSTON RD
Second Line	:	SUITE 500
City	:	HOUSTON
State	:	TX
Zip	:	77040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6306 FAIRBANKS N HOUSTON RD STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-5193
Country	:	US
Telephone Number	:	832-831-9094
Fax Number	:

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	04/10/2020

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Directions to “ BABATUNDE ADEBOLA OTINWA D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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