Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53642 | MN |
Y | 2080P0204X | Pediatric Emergency Doctor | 69628 | GA |
N | 2080P0204X | Pediatric Emergency Doctor | P0928 | TX |
NPI | 1265697775 |
---|---|
Provider Name | Dr. Olufunmilayo Ikponwosa Salami |
First Address | Atlanta, GA 30329-2304 |
Second Address | Atlanta, GA 30329-2304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 06/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P0928 | TEXAS MEDICAL BOARD (01) | TX |