Provider Demographics
NPI:1033383096
Name:OSEMOTA, SIMEON USIFO (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMEON
Middle Name:USIFO
Last Name:OSEMOTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 SW 26TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3809
Mailing Address - Country:US
Mailing Address - Phone:954-740-3162
Mailing Address - Fax:
Practice Address - Street 1:1796 US HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1918
Practice Address - Country:US
Practice Address - Phone:863-763-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065720207P00000X, 207Q00000X
TN49506207P00000X, 207Q00000X
FLME107057207P00000X, 207Q00000X
KY53498207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine