Provider Demographics
NPI:1215006069
Name:DR. SESI OGUNBI MD LLC
Entity type:Organization
Organization Name:DR. SESI OGUNBI MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SESI
Authorized Official - Middle Name:OLUFUNMILAYO
Authorized Official - Last Name:DOSUNMU-OGUNBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-288-6882
Mailing Address - Street 1:2055 E SOUTH BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2001
Mailing Address - Country:US
Mailing Address - Phone:334-288-6882
Mailing Address - Fax:334-288-2334
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2001
Practice Address - Country:US
Practice Address - Phone:334-288-6882
Practice Address - Fax:334-288-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16380174400000X, 2080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0009913375Medicaid
AL529913820Medicaid
AL0009913375Medicaid