Provider Demographics
NPI:1902234248
Name:ODEYEMI, IBIKUNLE DAVID
Entity Type:Individual
Prefix:
First Name:IBIKUNLE
Middle Name:DAVID
Last Name:ODEYEMI
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 1:11306 KETTERING WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MARYLAND
Mailing Address - Zip Code:20774
Mailing Address - Country:UM
Mailing Address - Phone:443-839-4336
Mailing Address - Fax:
Practice Address - Street 1:9300 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3114
Practice Address - Country:US
Practice Address - Phone:443-839-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide