Provider Demographics
NPI:1912742685
Name:BABALOLA, OLUWAGBEMISOLA KEMISOLA (MD)
Entity type:Individual
Prefix:
First Name:OLUWAGBEMISOLA
Middle Name:KEMISOLA
Last Name:BABALOLA
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 1:8.5 AFE BABALOLA WAY AFE BABALOLA MULTISYSTEM HOSPITAL,
Mailing Address - Street 2:
Mailing Address - City:ADO-EKITI
Mailing Address - State:EKITI STATE
Mailing Address - Zip Code:360001
Mailing Address - Country:NG
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN BLVD CHILDREN'S HOSPITAL OF MICHIGAN(PEDI
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4351053418208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics