Provider Demographics
NPI:1164562021
Name:KUFORIJI, ABAYOMI RASHEED (PT)
Entity Type:Individual
Prefix:MR
First Name:ABAYOMI
Middle Name:RASHEED
Last Name:KUFORIJI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20770 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3018
Mailing Address - Country:US
Mailing Address - Phone:248-968-2892
Mailing Address - Fax:248-968-2848
Practice Address - Street 1:20770 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3018
Practice Address - Country:US
Practice Address - Phone:248-968-2892
Practice Address - Fax:248-968-2848
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP21624Medicare UPIN