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SHAMUSIDEEN OLAYIBO OGBULU

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
500 JEFFERSON STREET, WHITEVILLE, NC 28472-3634
(910) 642-1776
Mailing address
PO BOX 601992, CHARLOTTE, NC 28260-1992
(910) 642-1776

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01065806A
IN
207R00000X
Internal Medicine Physician
2011-01350
NC
208M00000X
Hospitalist Physician
0101258916
VA
208M00000X
Hospitalist Physician
01065806A
IN
208M00000X
Hospitalist Physician
Primary
2011-01350
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000584350
ANTHEM PIN
IN
05
200913430
IN
05
5918627
NC
05
NC1486
SC
01
P00657204
RR MEDICARE PIN
IN
Enumeration date
09/08/2008
Last updated
08/23/2024
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