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Organization
VERDURE EXCLUSIVE PA
Active
Organization
VERDURE EXCLUSIVE PA
Active
Other names
Angelic Lift
Organization subpart
No
Provider details
NPI number
Authorized official
TINUADE OLUSEGUN MD (OWNER)
(386) 855-8633
Entity
Organization
Contact information
Practice address
4645 CLYDE MORRIS BLVD STE 404, PORT ORANGE, FL 32129-3005
(386) 855-8633
(855) 857-5810
Mailing address
4645 CLYDE MORRIS BLVD STE 404, PORT ORANGE, FL 32129-3005
(386) 855-8633
(855) 857-5810
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
07/09/2018
Last updated
12/13/2022
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