Organization
SHADOL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUMIDE OYEFESO M.D. (SOLE MEMBER)
(718) 300-4515
Entity
Organization
Contact information
Practice address
907 E REED ST, HAYTI, MO 63851-1242
(573) 359-3660
Mailing address
1800 TRUMAN BLVD, APT 11, CARUTHERSVILLE, MO 63830-2425
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
01/09/2008
Last updated
03/25/2008
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