Obaitan, Adebowale Anselm
Obaitan, Adebowale Anselm is an sole proprietor health care provider with primary practice located at 1430 Luckenbach Dr , Allen TX 75013-4632. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Obaitan, Adebowale Anselm can be contacted via phone (972) 390-8133.Contact Information
Primary practice address
1430 Luckenbach Dr
Allen TX 75013-4632
Phone: (972) 390-8133
Fax: (972) 390-9258
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 051994 | Georgia |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | M6319 | Texas |
Profile Details
| NPI number | 1518952142 |
|---|---|
| LBN Legal business name | Obaitan, Adebowale Anselm |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 20th, 2005 |
| Last updated | Jul 23rd, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518952142 | NPPES |
| Georgia | Other | 2211482626 | TRICARE SOUTH |
| Georgia | Other | 52025889003 | TRICARE SOUTH |
| Georgia | MEDICAID | 688786920C | TRICARE SOUTH |
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