Provider Demographics
NPI:1679175913
Name:BABALOLA, BABATUNDE
Entity Type:Individual
Prefix:
First Name:BABATUNDE
Middle Name:
Last Name:BABALOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 OAK HILL LN
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-2607
Mailing Address - Country:US
Mailing Address - Phone:773-419-3126
Mailing Address - Fax:469-277-4406
Practice Address - Street 1:1196 OAK HILL LN
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-2607
Practice Address - Country:US
Practice Address - Phone:773-419-3126
Practice Address - Fax:469-277-4406
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX793589163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator