Provider Demographics
NPI:1548502867
Name:OLUPONA, BAMIDELE (DPM)
Entity type:Individual
Prefix:
First Name:BAMIDELE
Middle Name:
Last Name:OLUPONA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 SW 37TH AVE STE 604
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2750
Mailing Address - Country:US
Mailing Address - Phone:305-587-4247
Mailing Address - Fax:866-834-5611
Practice Address - Street 1:2601 SW 37TH AVE STE 604
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2750
Practice Address - Country:US
Practice Address - Phone:305-587-4247
Practice Address - Fax:866-834-5611
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3757213EP1101X, 213ES0131X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program