Provider Demographics
NPI:1669603122
Name:FALADE, OLUFUNMILAYO OLUBUKOLA (MD)
Entity type:Individual
Prefix:
First Name:OLUFUNMILAYO
Middle Name:OLUBUKOLA
Last Name:FALADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 MAIN ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5369
Mailing Address - Country:US
Mailing Address - Phone:203-576-6259
Mailing Address - Fax:
Practice Address - Street 1:2800 MAIN ST
Practice Address - Street 2:DEPT OF CRITICAL CARE
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4201
Practice Address - Country:US
Practice Address - Phone:203-576-5436
Practice Address - Fax:203-581-6512
Is Sole Proprietor?:No
Enumeration Date:2009-08-01
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine