Individual
MATTHEW IDOWU OGUNSILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
216 ASHMORE BRIDGE RD, MAULDIN, SC 29662-2841
(864) 907-2537
(864) 281-1332
Mailing address
216 ASHMORE BRIDGE RD, MAULDIN, SC 29662-2841
(186) 490-7253
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
QIDP
SC
Other
Enumeration date
10/06/2021
Last updated
10/06/2021
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