Individual
MOSES O OLATUNJI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
11115 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 672-4000
(260) 672-6459
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01066506A
IN
208M00000X
Hospitalist Physician
01069915A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000641381
ANTHEM
IN
05
—
036087242
—
IL
05
—
200937490
—
IN
Enumeration date
03/22/2009
Last updated
01/30/2023
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