Provider Demographics
NPI:1548586977
Name:OLORUNTOBA, OMOBONIKE OYINDASOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:OMOBONIKE
Middle Name:OYINDASOLA
Last Name:OLORUNTOBA
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:PO BOX 63362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3362
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:40 MEDICINE CIRCLE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-3941
Practice Address - Country:US
Practice Address - Phone:919-684-6437
Practice Address - Fax:919-681-8147
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00594207R00000X, 207RI0008X, 207RT0003X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology