Provider Demographics
NPI:1447336623
Name:KOYA, IBIKUNLE OLAYEMI (MD)
Entity type:Individual
Prefix:DR
First Name:IBIKUNLE
Middle Name:OLAYEMI
Last Name:KOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1589 SULPHUR SPRING RD STE 109
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:410-536-5400
Mailing Address - Fax:410-737-2168
Practice Address - Street 1:1205 YORK RD STE 26
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6211
Practice Address - Country:US
Practice Address - Phone:410-532-1640
Practice Address - Fax:410-321-5787
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD42219207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD330441800Medicaid
MD181308Y56OtherMEDICARE - GROUP MEMBER PTAN
MD181308Y56OtherMEDICARE - GROUP MEMBER PTAN
MDF09787Medicare UPIN