Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | PO3757 | FL |
Y | 213ES0103X | Foot & Ankle Surgery | PO3757 | FL |
N | 213ES0131X | Foot Surgery | PO3757 | FL |
NPI | 1548502867 |
---|---|
Provider Name | Bamidele Olupona |
First Address | Miami, FL 33133-2751 |
Second Address | Miami, FL 33133-2751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 09/09/2021 |