MEDICARE: DR. ADEBUKOLA TAIWO 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
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	0090-00454	NC

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	:	1902884364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADEBUKOLA TAIWO MD

Provider Business Mailing Address
First Line	:	PO BOX 40908
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28309-0908
Country	:	US
Telephone Number	:	910-609-6448
Fax Number	:	910-609-7040

Provider Business Practice Location Address
First Line	:	101 ROBESON ST
Second Line	:	SUITE 202
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5552
Country	:	US
Telephone Number	:	910-609-1630
Fax Number	:	910-609-1636

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	05/20/2013

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