Provider Demographics
NPI:1376772939
Name:ODUMOSU, OLATUNJI (MD)
Entity Type:Individual
Prefix:
First Name:OLATUNJI
Middle Name:
Last Name:ODUMOSU
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 1:13515 83RD AVE APT 6N
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1568
Mailing Address - Country:US
Mailing Address - Phone:773-387-8217
Mailing Address - Fax:
Practice Address - Street 1:13515 83RD AVE APT 6N
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1568
Practice Address - Country:US
Practice Address - Phone:773-387-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program