Organization
SME INDIANA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUBUSOLA BRIMMO MD (OWNER)
(678) 977-5507
Entity
Organization
Contact information
Practice address
5728 PERGOLA DR APT 207, COLUMBIA, MO 65201-2897
(678) 977-5507
Mailing address
4321 COLLINGTON RD, BOWIE, MD 20716-2259
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
01/22/2019
Last updated
02/25/2019
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