Basic Information
| Provider Information | |||||||||
| NPI: | 1457559296 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWAL | ||||||||
| FirstName: | MOSHOOD | ||||||||
| MiddleName: | ADEBAYO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072837000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1165 W LODGEWOOD CT | ||||||||
| Address2: | |||||||||
| City: | RIVER HILLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532171637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704901156 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | TD091053 | ME | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 50599 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30208893 | 05 | NH | MEDICAID | 434469299 | 05 | ME | MEDICAID |