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Organization

ST. MARYGRACE FAMILY PRACTICE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ADENIKE A TINUBU MD (OWNER / OPERATOR / PHYSICIAN)
(337) 678-0918
Entity
Organization

Contact information

Practice address
1270 ATTAKAPAS DR, SUITE 404, OPELOUSAS, LA 70570-6549
(337) 678-0918
(337) 678-0927
Mailing address
1270 ATTAKAPAS DR, SUITE 404, OPELOUSAS, LA 70570-6549
(337) 678-0918
(337) 678-0927

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
202981
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1306055652
DR'S NPI
LA
05
4507245
LA
Enumeration date
08/23/2009
Last updated
03/18/2011
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