Active NPI
Kofo A Aderemi
- Durable Medical Equipment & Medical Supplies
- Dallas, TX
National Provider Identifier
1093951733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 59-4772
- Practice address
- 4617 S. Buckner Blvd., Suite J
Dallas, TX 75227 - Phone
- (504) 251-5564
- NPI assigned
- Dec 31, 2008
- Last updated
- Dec 31, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 59-4772 | LA | Primary |
Addresses
Primary practice location
4617 S. Buckner Blvd., Suite J
Dallas, TX 75227
Mailing address
4617 S. Buckner Blvd., Suite J
Dallas, TX 75227
Phone (504) 251-5564
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59-4772 | LA | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1230681600000",
"number": "1093951733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4617 S. BUCKNER BLVD., SUITE J",
"city": "DALLAS",
"state": "TX",
"postal_code": "75227",
"telephone_number": "504-251-5564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4617 S. BUCKNER BLVD., SUITE J",
"city": "DALLAS",
"state": "TX",
"postal_code": "75227",
"telephone_number": "504-251-5564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADEREMI",
"first_name": "KOFO",
"middle_name": "A",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-31",
"last_updated": "2008-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "LA",
"license": "59-4772",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.