Provider Demographics
NPI:1033300074
Name:OYENUGA, OLUSEGUN ADEWOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSEGUN
Middle Name:ADEWOLE
Last Name:OYENUGA
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 1:3001 E PRESIDENT GEORGE BUSH HWY STE 175
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3551
Mailing Address - Country:US
Mailing Address - Phone:972-941-3117
Mailing Address - Fax:844-289-7691
Practice Address - Street 1:3001 E PRESIDENT GEORGE BUSH HWY STE 175
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3551
Practice Address - Country:US
Practice Address - Phone:972-941-3117
Practice Address - Fax:844-289-7691
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437667207R00000X
IL036127256207RC0000X
TXQ5888207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349940203Medicaid
TX349940204Medicaid
TX349940205Medicaid