Provider Demographics
NPI:1508597394
Name:OLAGUNDOYE, TEMITOPE OLUWATOYIN
Entity Type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:OLUWATOYIN
Last Name:OLAGUNDOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8926 LIGHTHORSE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-4509
Mailing Address - Country:US
Mailing Address - Phone:317-772-7111
Mailing Address - Fax:
Practice Address - Street 1:8926 LIGHTHORSE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-4509
Practice Address - Country:US
Practice Address - Phone:317-772-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN88-2912197OtherPERSONAL CARE SERVICE PROVIDER
88-2912197OtherPERSONAL CARE ATTENDANT