Individual
DR. OLAJIDE A. BALOGUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1165 HIGHWAY 1 S, SUITE 200, LUGOFF, SC 29078-8966
(803) 408-0225
(803) 408-0729
Mailing address
1165 HIGHWAY 1 S, SUITE 200, LUGOFF, SC 29078-8966
(803) 408-0225
(803) 408-0729
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20381
SC
208000000X
Pediatrics Physician
20381
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
203817
—
SC
Enumeration date
03/27/2006
Last updated
12/13/2007
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