Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301090918 | MI |
Y | 111NI0900X | Internist | 4301090918 | MI |
NPI | 1992996631 |
---|---|
Provider Name | Dr. Funlola Ibimina Famuyiwa |
First Address | Reisterstown, MD 21136-2731 |
Second Address | Reisterstown, MD 21136-2731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 02/06/2008 |