Provider Demographics
NPI:1477846772
Name:ODUMOSU, OLUTONI OMOTOMILOLA (MD)
Entity Type:Individual
Prefix:
First Name:OLUTONI
Middle Name:OMOTOMILOLA
Last Name:ODUMOSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:IDOWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18102 DOCKSIDE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5037
Mailing Address - Country:US
Mailing Address - Phone:972-835-2700
Mailing Address - Fax:
Practice Address - Street 1:9915 BARKER CYPRESS RD STE 200
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1203
Practice Address - Country:US
Practice Address - Phone:281-737-1555
Practice Address - Fax:281-737-1556
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10040638207Q00000X
TXP7525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine