Provider Demographics
NPI:1922337088
Name:PROPERCARE INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:PROPERCARE INTERNAL MEDICINE PA
Other - Org Name:OLUBAYO IDOWU MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLATUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-283-8777
Mailing Address - Street 1:2727 BOLTON BOONE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:972-283-8777
Mailing Address - Fax:972-283-9333
Practice Address - Street 1:2727 BOLTON BOONE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2019
Practice Address - Country:US
Practice Address - Phone:972-283-8777
Practice Address - Fax:972-283-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK06009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK06009OtherLICENSE
TXM1276OtherLICENSE
TXTXB101109Medicare PIN
TXTXB101108OtherMEDICARE