Olabimpe Cynthia Fasuyi
Individual provider Active NPI Driver · Indianapolis, IN
NPI 1063243236 · NPPES record last updated Aug 9, 2024
Key facts
- NPI
- 1063243236
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 9370519152 (IN)
- Practice address
- 3438 W Glenarm Dr
Indianapolis, IN 46224 - Phone
- (304) 319-1366
- NPI assigned
- Aug 9, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9370519152 | IN | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 9370519152 | IN | Yes |
Addresses
Primary practice location
3438 W Glenarm Dr
Indianapolis, IN 46224
Mailing address
3438 W Glenarm Dr
Indianapolis, IN 46224
Phone (304) 319-1366
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.