Provider Demographics
NPI:1346244324
Name:OGUNTOLU, OLUSOLA OLANREWAJU (MD)
Entity Type:Individual
Prefix:
First Name:OLUSOLA
Middle Name:OLANREWAJU
Last Name:OGUNTOLU
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 1:5543 EDMONDSON PIKE
Mailing Address - Street 2:# 44
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5808
Mailing Address - Country:US
Mailing Address - Phone:615-321-7255
Mailing Address - Fax:615-321-7259
Practice Address - Street 1:2900 FELICIA ST
Practice Address - Street 2:STE 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4042
Practice Address - Country:US
Practice Address - Phone:615-321-7255
Practice Address - Fax:615-321-7259
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2011-02-02
Deactivation Date:2006-03-29
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
TNMD36290207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4043600OtherBC/BS
TN5347585OtherAETNA
TN3381539Medicaid
TN3381539Medicaid
TNG35606Medicare UPIN