Provider Demographics
NPI:1386675254
Name:LERAMO, OLUSEGUN B (MD)
Entity Type:Individual
Prefix:
First Name:OLUSEGUN
Middle Name:B
Last Name:LERAMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8805 OMEARA CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-2141
Mailing Address - Country:US
Mailing Address - Phone:661-664-4640
Mailing Address - Fax:661-872-1915
Practice Address - Street 1:2601 OSWELL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3156
Practice Address - Country:US
Practice Address - Phone:661-872-9999
Practice Address - Fax:661-872-1915
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC43014207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG17793Medicare UPIN