Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 04-32614 | KS |
Y | 207RP1001X | Pulmonary Disease | 04-32614 | KS |
N | 207RS0012X | Sleep Medicine | 04-32614 | KS |
NPI | 1043231228 |
---|---|
Provider Name | Theophilus Tolulope Ogungbamigbe |
First Address | Topeka, KS 66606-1764 |
Second Address | Topeka, KS 66606-1764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 09/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106587 | MEDICARE PTAN (01) | KS |
200438400A | (05) | KS |
230637 | LICENSE (01) | NY |
P00426465 | RAILROAD MEDICARE (01) | KS |