Provider Demographics
NPI:1780956557
Name:FAPARUSI, OLUYOMI SR (MD, JD, PHD)
Entity type:Individual
Prefix:
First Name:OLUYOMI
Middle Name:
Last Name:FAPARUSI
Suffix:SR
Gender:M
Credentials:MD, JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 WHEATLEY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8342
Mailing Address - Country:US
Mailing Address - Phone:410-375-9817
Mailing Address - Fax:
Practice Address - Street 1:1274 WHEATLEY FOREST DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8342
Practice Address - Country:US
Practice Address - Phone:410-375-9817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54688-202083P0901X, 209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine