Doctor Name: | DR. PATRICK KOLA FADAHUNSI |
NPI Number: | 1609987437 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | H3034 |
Business Practice Address: | 1704 N Hampton Rd Ste. 209 Desoto, TX - 751158623 |
Business Phone Number: | 2143375080 |
Business Fax Number: | 2143375844 |
Mailing Address: | 1704 N Hampton Rd Ste 209, DESOTO |
State: | TX |
Postal Code: | 751158623 |
Phone Number: | 2143375080 |
Fax Number: | 2143375844 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 05/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | H3034 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |