Provider Demographics
NPI:1164483327
Name:OMITOWOJU, OLAYINKA OLATOKUNBO (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAYINKA
Middle Name:OLATOKUNBO
Last Name:OMITOWOJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:920 W MARKET ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2773
Mailing Address - Country:US
Mailing Address - Phone:419-229-3362
Mailing Address - Fax:419-229-8258
Practice Address - Street 1:920 W MARKET ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2773
Practice Address - Country:US
Practice Address - Phone:419-229-3362
Practice Address - Fax:419-229-8258
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-06-9546-0207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0225125Medicaid
OH0225125Medicaid
OHG25548Medicare UPIN