Basic Information
| Provider Information | |||||||||
| NPI: | 1912566779 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OLUWAYEMISI RADIOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1547 | ||||||||
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| City: | SEDALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653021547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608265960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 W FERTITTA BLVD | ||||||||
| Address2: | |||||||||
| City: | LEESVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714464645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608265960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2019 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | OJEMAKINDE | ||||||||
| AuthorizedOfficialFirstName: | OLUWAYEMISI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3372395148 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.