Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 18315 | MS |
NPI | 1073567251 |
---|---|
Provider Name | Olufemi Adeleye |
First Address | Southaven, MS 38671-0005 |
Second Address | Southaven, MS 38671-9504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 12/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06180721 | (05) | MS |
F47915 | (02) |