Basic Information
| Provider Information | |||||||||
| NPI: | 1669603122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALADE | ||||||||
| FirstName: | OLUFUNMILAYO | ||||||||
| MiddleName: | OLUBUKOLA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2660 MAIN ST | ||||||||
| Address2: | SUITE 216 | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066065369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035766259 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 MAIN ST | ||||||||
| Address2: | DEPT OF CRITICAL CARE | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066064201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035765436 | ||||||||
| FaxNumber: | 2035816512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2009 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 53421 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.