Provider Demographics
NPI:1700181062
Name:KUTEMI, ABIODUN
Entity Type:Individual
Prefix:
First Name:ABIODUN
Middle Name:
Last Name:KUTEMI
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 1:10315 W AIRPORT BLVD
Mailing Address - Street 2:STE 8
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3342
Mailing Address - Country:US
Mailing Address - Phone:281-495-9838
Mailing Address - Fax:281-495-9803
Practice Address - Street 1:10315 W AIRPORT BLVD
Practice Address - Street 2:STE 8
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3342
Practice Address - Country:US
Practice Address - Phone:281-495-9838
Practice Address - Fax:281-495-9803
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
6472600001Medicare NSC