Provider Demographics
NPI:1972558286
Name:ANIFOWOSHE, OLUMIDE IBRAHIM (MD)
Entity type:Individual
Prefix:
First Name:OLUMIDE
Middle Name:IBRAHIM
Last Name:ANIFOWOSHE
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 1:200 STONECREST BLVD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6810
Mailing Address - Country:US
Mailing Address - Phone:615-768-2000
Mailing Address - Fax:615-768-2707
Practice Address - Street 1:200 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6810
Practice Address - Country:US
Practice Address - Phone:615-768-2000
Practice Address - Fax:615-768-2707
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37852208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38892822Medicaid
TN38892822Medicaid
H98796Medicare UPIN
TN38892822Medicare PIN