Provider Demographics
NPI:1083001747
Name:OYEWOLE, OYEDOTUN (MD)
Entity Type:Individual
Prefix:
First Name:OYEDOTUN
Middle Name:
Last Name:OYEWOLE
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 1:919 W MAIN ST STE M5
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6804
Mailing Address - Country:US
Mailing Address - Phone:615-239-1845
Mailing Address - Fax:
Practice Address - Street 1:919 W MAIN ST STE M5
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6804
Practice Address - Country:US
Practice Address - Phone:615-239-1845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57733207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist