Provider Demographics
NPI:1992344030
Name:OMITOGUN AND ASSOCIATES PLLC
Entity type:Organization
Organization Name:OMITOGUN AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMITOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-409-4090
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-0862
Mailing Address - Country:US
Mailing Address - Phone:281-942-8001
Mailing Address - Fax:
Practice Address - Street 1:12234 SHADOW CREEK PKWY STE 5104
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7334
Practice Address - Country:US
Practice Address - Phone:281-942-8001
Practice Address - Fax:281-724-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty