Provider Demographics
NPI:1407847049
Name:OKANLAMI, OLUBUNMI ABOSEDE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUBUNMI
Middle Name:ABOSEDE
Last Name:OKANLAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51310 SHAMROCK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7821
Mailing Address - Country:US
Mailing Address - Phone:574-532-6280
Mailing Address - Fax:
Practice Address - Street 1:615 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1033
Practice Address - Country:US
Practice Address - Phone:574-647-7426
Practice Address - Fax:574-647-6780
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042229A208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200029310Medicaid
IN000000370175OtherBCBS MEMORIAL CHILDRENS HOSPITAL
IN000000370175OtherBCBS MEMORIAL CHILDRENS HOSPITAL
INE77137Medicare UPIN