Provider Demographics
NPI:1356792790
Name:KUSIMO, IBUKUNOLUWA OLUWAPELUMI (DO)
Entity type:Individual
Prefix:
First Name:IBUKUNOLUWA
Middle Name:OLUWAPELUMI
Last Name:KUSIMO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:IBUKUNOLUWA
Other - Middle Name:OLUWAPELUMI
Other - Last Name:PICKENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:500 MARKAVIEW RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-3652
Mailing Address - Country:US
Mailing Address - Phone:256-535-3100
Mailing Address - Fax:
Practice Address - Street 1:333 WHITESPORT DR SW STE 304
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3455
Practice Address - Country:US
Practice Address - Phone:256-469-0350
Practice Address - Fax:256-291-3611
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1739207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine