Provider Demographics
NPI:1598717738
Name:FALEYE, OLUGBENGA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUGBENGA
Middle Name:
Last Name:FALEYE
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 1:6637 SUMMER KNOLL CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2875
Mailing Address - Country:US
Mailing Address - Phone:901-372-5260
Mailing Address - Fax:
Practice Address - Street 1:6637 SUMMER KNOLL CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2875
Practice Address - Country:US
Practice Address - Phone:901-372-5260
Practice Address - Fax:901-386-8726
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3857517Medicaid
TN3857517Medicaid
TNG62362Medicare UPIN