Provider Demographics
NPI:1073737367
Name:ODUGBESAN, OLUYEMISI MODUPEORE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUYEMISI
Middle Name:MODUPEORE
Last Name:ODUGBESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:OLUYEMISI
Other - Middle Name:MODUPEORE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPA
Mailing Address - Street 1:6175 S BOSTON CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5242
Mailing Address - Country:US
Mailing Address - Phone:720-515-4485
Mailing Address - Fax:
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:973-322-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.141249207L00000X
NY307759207L00000X
CO51427207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56277237Medicaid
COCOA108190Medicare PIN