Basic Information
| Provider Information | |||||||||
| NPI: | 1538579826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FATOKUN | ||||||||
| FirstName: | TOLULOPE | ||||||||
| MiddleName: | BAMIDELE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1080 | ||||||||
| Address2: | |||||||||
| City: | BURKESVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427171080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708586655 | ||||||||
| FaxNumber: | 2708584027 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 BOGLE ST | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066780705 | ||||||||
| FaxNumber: | 6066782807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2014 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | TP916 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.