Individual
IFEKAN-SHANGO SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
853 N CHURCH ST, SUITE 510, SPARTANBURG, SC 29303-3098
(864) 560-1558
Mailing address
853 N CHURCH ST, SUITE 510, SPARTANBURG, SC 29303-3077
(864) 560-1558
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22352
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223528
—
SC
Enumeration date
05/31/2006
Last updated
08/20/2013
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