Provider Demographics
NPI:1851052468
Name:CONNECTDCARE FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:CONNECTDCARE FAMILY PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PCP
Authorized Official - Prefix:DR
Authorized Official - First Name:KEMI
Authorized Official - Middle Name:FUNLAYO
Authorized Official - Last Name:OGUNWUSI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP
Authorized Official - Phone:302-744-8438
Mailing Address - Street 1:888 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4148
Mailing Address - Country:US
Mailing Address - Phone:302-744-8438
Mailing Address - Fax:302-744-8425
Practice Address - Street 1:888 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4148
Practice Address - Country:US
Practice Address - Phone:302-744-8438
Practice Address - Fax:302-744-8425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250699611Medicaid
DE250699628Medicaid
DE250735442Medicaid