Dr. Temidayo Olugbenga Odugbesan, M.D., SA-C
Student in an Organized Health Care Education/Training Program in Montgomery, AL. Individual provider (NPI-1).
Details
- NPI
- 1477909448
- Entity type
- Individual (NPI-1)
- Name
- Dr. Temidayo Olugbenga Odugbesan
- Credential
- M.D., SA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 10, 2016
- Certification date
- Jun 13, 2024
- Last updated
- Jun 13, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - FAMILY PRACTICE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 363AS0400X | Physician Assistant, Surgical | 238.000495 | IL |
Practice location
6117 Boardwalk Blvd Apt JMontgomery, AL 36117-2812
Phone 872-806-4250
Mailing address
2024 Chestnut StMontgomery, AL 36106-1111
Phone 334-440-3061
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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