Individual
IFEOLUWA BALOGUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
230 W 17TH ST, NEW YORK, NY 10011-5325
(212) 206-5200
Mailing address
230 W 17TH ST, NEW YORK, NY 10011-5325
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
167320
FL
207Q00000X
Family Medicine Physician
Primary
323967
NY
207Q00000X
Family Medicine Physician
ME161809
FL
Other
Enumeration date
06/19/2019
Last updated
07/20/2023
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