Organization
GLORY MEDCLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID OMOTAYO IKUDAYISI M.D. (PRESIDENT)
(813) 932-9798
Entity
Organization
Contact information
Practice address
8019 N HIMES AVE, SUITE 200, TAMPA, FL 33614-2712
(813) 932-9798
(813) 935-5178
Mailing address
8019 N HIMES AVE, SUITE 200, TAMPA, FL 33614-2712
(813) 932-9798
(813) 935-5178
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
FL
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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