Individual
DR. OLUSEYI FADEGBOLA OGUNDIMU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
661 FISHER DR, SULLIVAN, MO 63080-1533
(573) 860-3000
(573) 860-3004
Mailing address
190 INDUSTRIAL DR, FESTUS, MO 63028-4133
(636) 777-2245
(636) 777-2208
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2014010100
MO
207LP2900X
Pain Medicine (Anesthesiology) Physician
4301103019
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700016250
—
MO
Enumeration date
07/17/2009
Last updated
07/07/2014
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