Provider Demographics
NPI:1467444877
Name:OLUKOGA, CHRISTOPHER OLUSEGUN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:OLUSEGUN
Last Name:OLUKOGA
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 1:1925 MIZELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4155
Mailing Address - Country:US
Mailing Address - Phone:407-303-7399
Mailing Address - Fax:407-303-7305
Practice Address - Street 1:1925 MIZELL AVE STE 201
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4155
Practice Address - Country:US
Practice Address - Phone:407-303-7399
Practice Address - Fax:407-303-7305
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084596208600000X
PAMD437268208600000X
FLME125287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64094881Medicaid
OH2494206Medicaid
OH2494206Medicaid
KY64094881Medicaid