Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 42024 | KY |
N | 2080P0205X | Pediatric Endocrinologist | 35.086930 | OH |
Y | 2080P0205X | Pediatric Endocrinologist | 42024 | KY |
NPI | 1427275049 |
---|---|
Provider Name | Dr. Adetokunbo Olukorede Omoruyi |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 09/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200919290 | (05) | IN |
7100062650 | (05) | KY |