Provider Demographics
NPI:1992996631
Name:FAMUYIWA, FUNLOLA IBIMINA
Entity type:Individual
Prefix:DR
First Name:FUNLOLA
Middle Name:IBIMINA
Last Name:FAMUYIWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLUFUNLOLA
Other - Middle Name:IBIMINA
Other - Last Name:ONAFOWOKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 BROOKEBURY DR
Mailing Address - Street 2:APT 1B
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2731
Mailing Address - Country:US
Mailing Address - Phone:615-496-2247
Mailing Address - Fax:
Practice Address - Street 1:111 BROOKEBURY DR
Practice Address - Street 2:APT 1B
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2731
Practice Address - Country:US
Practice Address - Phone:615-496-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine