Individual
ABIODUN SANGOSENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17 GINGER CREEK MDWS, GLEN CARBON, IL 62034-3508
(800) 968-6866
Mailing address
PO BOX 66971, DEPT LE, SAINT LOUIS, MO 63166-6971
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196690
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/13/2005
Last updated
08/07/2007
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