Provider Demographics
NPI:1346858701
Name:OLUPONA FOOT AND ANKLE
Entity Type:Organization
Organization Name:OLUPONA FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BAMIDELE
Authorized Official - Middle Name:OLUGBENGA
Authorized Official - Last Name:OLUPONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-321-8812
Mailing Address - Street 1:2601 SW 37TH AVE STE 904
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18623 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6804
Practice Address - Country:US
Practice Address - Phone:305-238-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty