Dr. M. K. Onifade Internal Medicine Practice LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2002019255 Issued in MO

Legal business name

DR. M. K. ONIFADE INTERNAL MEDICINE PRACTICE LLC

Practice address

2880 Netherton Dr Ste 200
Saint Louis, MO 63136-4697

Phone

(314) 355-5300

Fax

(314) 521-4656

NPI assigned

May 15, 2007

Last updated

Oct 21, 2024By 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

Dr. Moyosore Kikelomo Onifade, M.D.NPI 1669586954

Title

Manager

Phone

(314) 355-5300

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

• Moyosore Kikelomo Onifade, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1669586954
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1932315942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2880 NETHERTON DR STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631364697",
            "telephone_number": "314-355-5300",
            "fax_number": "314-521-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 NETHERTON DR STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631364697",
            "telephone_number": "314-355-5300",
            "fax_number": "314-521-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. M. K. ONIFADE INTERNAL MEDICINE PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "ONIFADE",
        "authorized_official_first_name": "MOYOSORE",
        "authorized_official_middle_name": "KIKELOMO",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "314-355-5300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2002019255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208818716",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.