Provider Demographics
NPI:1003854449
Name:SHOLABI, ISIAKA OLAWALE (MD)
Entity Type:Individual
Prefix:
First Name:ISIAKA
Middle Name:OLAWALE
Last Name:SHOLABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 BROAD ST APT 707A
Mailing Address - Street 2:NEWARK,NJ
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-5314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:646-417-1127
Practice Address - Street 1:3050 COMMERCE DR
Practice Address - Street 2:SUITE C CREDENTIALS
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3819
Practice Address - Country:US
Practice Address - Phone:810-385-8086
Practice Address - Fax:810-385-4933
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087339208M00000X
GA061654208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301087339OtherPHYSICIAN LICENSE