Provider Demographics
NPI:1063834349
Name:ODETUNMIBI, OLABIMPE
Entity Type:Individual
Prefix:
First Name:OLABIMPE
Middle Name:
Last Name:ODETUNMIBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 PRESTON OAKS RD APT 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8713
Mailing Address - Country:US
Mailing Address - Phone:214-694-7698
Mailing Address - Fax:
Practice Address - Street 1:5801 PRESTON OAKS RD APT 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8713
Practice Address - Country:US
Practice Address - Phone:214-694-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage