Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 4301081420 | MI |
NPI | 1184735698 |
---|---|
Provider Name | Olufemi O Soyode |
First Address | Grand Rapids, MI 49505-6028 |
Second Address | Grand Rapids, MI 49505-6028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184735698 | (05) | MI |