Provider Demographics
NPI:1386804334
Name:OSUNTOGUN, EZEKIEL ADEREMI (MD)
Entity type:Individual
Prefix:DR
First Name:EZEKIEL
Middle Name:ADEREMI
Last Name:OSUNTOGUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46577
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0105
Mailing Address - Country:US
Mailing Address - Phone:813-727-2650
Mailing Address - Fax:
Practice Address - Street 1:13601 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUIT 121
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4657
Practice Address - Country:US
Practice Address - Phone:813-454-1113
Practice Address - Fax:813-454-1114
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106194207QA0401X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine