Provider Demographics
NPI:1376756684
Name:OYEKOLA, LATIFAT A (MD)
Entity Type:Individual
Prefix:DR
First Name:LATIFAT
Middle Name:A
Last Name:OYEKOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LATIFAT
Other - Middle Name:ADEBANKE
Other - Last Name:OGON.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6357 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3920
Mailing Address - Country:US
Mailing Address - Phone:317-757-2563
Mailing Address - Fax:317-405-9970
Practice Address - Street 1:6357 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3920
Practice Address - Country:US
Practice Address - Phone:317-757-2563
Practice Address - Fax:317-405-9970
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5732207Q00000X
IN01073129A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201185350Medicaid
IN201185350Medicaid