Provider Demographics
NPI:1235137613
Name:SENU-OKE, OLUSEYI NUTAYI (MD)
Entity Type:Individual
Prefix:MR
First Name:OLUSEYI
Middle Name:NUTAYI
Last Name:SENU-OKE
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 1:4011 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2219
Mailing Address - Country:US
Mailing Address - Phone:302-762-0200
Mailing Address - Fax:302-762-0500
Practice Address - Street 1:4011 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2219
Practice Address - Country:US
Practice Address - Phone:302-762-0200
Practice Address - Fax:302-762-0500
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5253610001Medicare NSC
DEG00245Medicare PIN