Provider Demographics
NPI:1982877387
Name:OLUTIMEHIN, BABAJIDE OLATOKUNBO (MD)
Entity Type:Individual
Prefix:DR
First Name:BABAJIDE
Middle Name:OLATOKUNBO
Last Name:OLUTIMEHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 QUIET FALLS DR.
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4967
Mailing Address - Country:US
Mailing Address - Phone:832-209-6165
Mailing Address - Fax:281-692-1108
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064472A207Q00000X
TXN1034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BC553OtherBCBS
TX197628401Medicaid
TX197628401Medicaid