Individual
DR. KHADIJAT OMOLOLA BALOGUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
353 MAIN ST, MANCHESTER, CT 06040-4145
(860) 649-3477
(860) 649-0011
Mailing address
353 MAIN ST, MANCHESTER, CT 06040-4145
(860) 649-3477
(860) 649-0011
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
56518
CT
Other
Enumeration date
05/16/2011
Last updated
07/21/2022
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