Provider Demographics
NPI:1548423114
Name:BADERO, OLUROTIMI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUROTIMI
Middle Name:
Last Name:BADERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-4134
Mailing Address - Country:US
Mailing Address - Phone:601-398-0904
Mailing Address - Fax:601-398-2149
Practice Address - Street 1:5240 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4134
Practice Address - Country:US
Practice Address - Phone:601-398-0904
Practice Address - Fax:601-398-2149
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21527207RC0000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology