Provider Demographics
NPI:1033465893
Name:OLANREWAJU, IFEDOLAPO SULYMAN (MD)
Entity Type:Individual
Prefix:
First Name:IFEDOLAPO
Middle Name:SULYMAN
Last Name:OLANREWAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1000 RIVERWALK BLVD
Mailing Address - Street 2:APT 709
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2717
Mailing Address - Country:US
Mailing Address - Phone:318-528-7946
Mailing Address - Fax:318-449-2320
Practice Address - Street 1:3330 MASONIC DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3841
Practice Address - Country:US
Practice Address - Phone:318-487-1122
Practice Address - Fax:318-449-2320
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61378636207Q00000X
LAMD. 208226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine