Provider Demographics
NPI:1033759089
Name:BALOGUN, KAYODE M (MD)
Entity Type:Individual
Prefix:
First Name:KAYODE
Middle Name:M
Last Name:BALOGUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:941-202-5342
Practice Address - Street 1:6551 RIDGE RD STE 2
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6868
Practice Address - Country:US
Practice Address - Phone:727-846-0666
Practice Address - Fax:727-849-1474
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2023-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2019014740208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice