Provider Demographics
NPI:1013182013
Name:OGUNLESI, OLUSEGUN ADEMOLA (MD, MHS)
Entity Type:Individual
Prefix:DR
First Name:OLUSEGUN
Middle Name:ADEMOLA
Last Name:OGUNLESI
Suffix:
Gender:M
Credentials:MD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8587 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4301
Mailing Address - Country:US
Mailing Address - Phone:440-867-4800
Mailing Address - Fax:866-711-5107
Practice Address - Street 1:8587 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4301
Practice Address - Country:US
Practice Address - Phone:440-867-4800
Practice Address - Fax:866-711-5107
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086600207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2868599Medicaid
OH4295531Medicare PIN