Provider Demographics
NPI:1902243694
Name:IBIKUNLE, SAMUEL OLATUNBOSUN
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:OLATUNBOSUN
Last Name:IBIKUNLE
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 1:6317 LANDOVER RD
Mailing Address - Street 2:APT 303
Mailing Address - City:CHERVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785
Mailing Address - Country:US
Mailing Address - Phone:240-501-1673
Mailing Address - Fax:
Practice Address - Street 1:6317 LANDOVER RD
Practice Address - Street 2:APT 303
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1318
Practice Address - Country:US
Practice Address - Phone:240-501-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide