Provider Demographics
NPI:1043348048
Name:BALOGUN, EVELYN KEMI (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:KEMI
Last Name:BALOGUN
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3401 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5103
Mailing Address - Country:US
Mailing Address - Phone:215-707-8150
Mailing Address - Fax:215-707-5751
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-8150
Practice Address - Fax:215-707-5751
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4227952083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine