Omotayo Fawibe MD LLC

Primary specialty

Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X

Legal business name

OMOTAYO FAWIBE MD LLC

Practice address

14726 Amera Cir
Fort Wayne, IN 46845-0027

Phone

(832) 606-7941

NPI assigned

Dec 9, 2021

Last updated

Dec 9, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Omotayo FawibeNPI 1851634554

Title

Owner

Phone

(832) 606-7941

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Omotayo Temitope Fawibe, MD

  • Occupational Medicine Physician
  • Fort Wayne, IN
  • NPI 1851634554

  Preventive Medicine/Occupational Environmental Medicine

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639008000000",
    "number": "1295494029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14726 AMERA CIR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468450027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14726 AMERA CIR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468450027",
            "telephone_number": "832-606-7941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMOTAYO FAWIBE MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A",
        "authorized_official_last_name": "FAWIBE",
        "authorized_official_first_name": "OMOTAYO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "832-606-7941"
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preventive Medicine/Occupational Environmental Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Preventive Medicine/Occupational Environmental Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.