Individual
DR. OMOTAYO TEMITOPE FAWIBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3978 NEW VISION DR, FORT WAYNE, IN 46845
(260) 672-4680
(260) 458-5836
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
01076903A
IN
2083X0100X
Occupational Medicine Physician
S5894
TX
Other
Enumeration date
04/01/2013
Last updated
07/24/2023
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