Provider Demographics
NPI:1558608372
Name:BAMIGBADE, FOLAKE OLUYEMISI (PROGRAM MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:FOLAKE
Middle Name:OLUYEMISI
Last Name:BAMIGBADE
Suffix:
Gender:F
Credentials:PROGRAM MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13279 POND SPRINGS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7161
Mailing Address - Country:US
Mailing Address - Phone:512-850-0516
Mailing Address - Fax:
Practice Address - Street 1:13279 POND SPRINGS RD STE 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7161
Practice Address - Country:US
Practice Address - Phone:512-850-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27-5070607OtherIRS