Provider Demographics
NPI:1407343551
Name:FAMUYIRO, TOLULOPE (MD)
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:FAMUYIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TOLULOPE
Other - Middle Name:
Other - Last Name:AKINTIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8585 PICARDY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3749
Mailing Address - Country:US
Mailing Address - Phone:225-763-4764
Mailing Address - Fax:617-228-6306
Practice Address - Street 1:8585 PICARDY AVE STE 400
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3749
Practice Address - Country:US
Practice Address - Phone:225-763-4764
Practice Address - Fax:617-228-6306
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101271156207QG0300X
390200000X
MA288037207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1407343551Medicaid