Provider Demographics
NPI:1942864871
Name:FALAIYE, TAIWO AGNES (MD)
Entity type:Individual
Prefix:
First Name:TAIWO
Middle Name:AGNES
Last Name:FALAIYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAIWO
Other - Middle Name:AGNES
Other - Last Name:OYEDEJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3012 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-6144
Mailing Address - Country:US
Mailing Address - Phone:219-877-3841
Mailing Address - Fax:
Practice Address - Street 1:3012 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6144
Practice Address - Country:US
Practice Address - Phone:219-877-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01091007A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine