Provider Demographics
NPI:1033759089
Name:BALOGUN, KAYODE MOSHOOD (MD)
Entity type:Individual
Prefix:
First Name:KAYODE
Middle Name:MOSHOOD
Last Name:BALOGUN
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 1:7236 STATE ROAD 52 STE 13
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6749
Mailing Address - Country:US
Mailing Address - Phone:727-233-6084
Mailing Address - Fax:727-255-5128
Practice Address - Street 1:7236 STATE ROAD 52 STE 13
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6749
Practice Address - Country:US
Practice Address - Phone:727-233-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY587962083P0901X
FLACN1417208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice