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Organization
PROGRESSIVE PHYSICIANS PRACTICE
Active
Organization
PROGRESSIVE PHYSICIANS PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REMILEKUN SUBEDAT ADESOJI MD (OWNER)
(662) 536-2100
Entity
Organization
Contact information
Practice address
8412 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5140
(662) 536-2100
(662) 536-2211
Mailing address
PO BOX 1078, SOUTHAVEN, MS 38671
(662) 536-2100
(662) 536-2211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16532
MS
208000000X
Pediatrics Physician
16591
MS
Other
Enumeration date
11/03/2006
Last updated
11/04/2010
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