| Doctor Name: | MR. OLUMIDE SAMSON FAGBEMI |
| NPI Number: | 1013163765 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 6478 MC |
| Business Practice Address: | 387 Mackinaw Ave Calumet City, IL - 604092513 |
| Business Phone Number: | 7087852238 |
| Business Fax Number: | 7084010098 |
| Mailing Address: | 387 Mackinaw Ave, CALUMET CITY |
| State: | IL |
| Postal Code: | 604092513 |
| Phone Number: | 7087852238 |
| Fax Number: | 7084010098 |
| NPI Enumeration Date: | 08/13/2008 |
| NPI Last Update Date: | 08/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 343900000X |
| License Number: | 6478 MC |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Non-emergency Medical Transport (VAN) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. |