Provider Demographics
NPI:1508357849
Name:KUTEYI, OLAJIDE O
Entity Type:Individual
Prefix:
First Name:OLAJIDE
Middle Name:O
Last Name:KUTEYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 CHESTERTON SQ N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2622
Mailing Address - Country:US
Mailing Address - Phone:301-323-3105
Mailing Address - Fax:
Practice Address - Street 1:1394 CHESTERTON SQ N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2622
Practice Address - Country:US
Practice Address - Phone:301-323-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH167982164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty