MEDICARE: MUYINAT YEWANDE OSOBA

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	207Y00000X	Otolaryngology Physician	D0100544	MD
2	207Y00000X	Otolaryngology Physician	125073699	IL

General Provider Information

NPI Number	:	1982100525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUYINAT YEWANDE OSOBA

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:
Fax Number	:	240-236-9865

Provider Business Practice Location Address
First Line	:	11085 LITTLE PATUXENT PKWY STE 101
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2914
Country	:	US
Telephone Number	:	410-955-5000
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/07/2025

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