Organization
INTERNAL MEDICINE & INDUSTRIAL MEDICINE CLINIC P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUBAYO AYOTUNDE IDOWU M.D (MEDICAL DIRECTOR)
(972) 283-8777
Entity
Organization
Contact information
Practice address
2727 BOLTON BOONE DR, 102, DESOTO, TX 75115-2019
(972) 283-8777
(972) 283-9333
Mailing address
2727 BOLTON BOONE DR, 102, DESOTO, TX 75115-2019
(972) 283-8777
(972) 283-9333
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0033EV
BCBS
TX
Enumeration date
03/21/2006
Last updated
08/22/2020
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