Provider Demographics
NPI:1356308381
Name:OLATUNJI, ADEBOLA SULAIMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEBOLA
Middle Name:SULAIMAN
Last Name:OLATUNJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:650 SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3346
Mailing Address - Country:US
Mailing Address - Phone:817-386-9818
Mailing Address - Fax:817-386-9821
Practice Address - Street 1:654 SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3358
Practice Address - Country:US
Practice Address - Phone:817-386-9818
Practice Address - Fax:817-386-9821
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167928402Medicaid
I17311Medicare UPIN