Provider Demographics
NPI:1568080794
Name:AWOLOPE, ROLAND OLASUNKANMI
Entity Type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:OLASUNKANMI
Last Name:AWOLOPE
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 1:3916 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2859
Mailing Address - Country:US
Mailing Address - Phone:269-873-4532
Mailing Address - Fax:
Practice Address - Street 1:3916 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2859
Practice Address - Country:US
Practice Address - Phone:269-873-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS390402971251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health