Provider Demographics
NPI:1568470045
Name:SORUMKE, OLALEKAM ADIGUM
Entity Type:Individual
Prefix:MR
First Name:OLALEKAM
Middle Name:ADIGUM
Last Name:SORUMKE
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 1:10935 ESTATE LN
Mailing Address - Street 2:SUITE 274
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2316
Mailing Address - Country:US
Mailing Address - Phone:214-553-2544
Mailing Address - Fax:214-503-0315
Practice Address - Street 1:10935 ESTATE LANE
Practice Address - Street 2:STE.274
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238
Practice Address - Country:US
Practice Address - Phone:214-553-2544
Practice Address - Fax:214-503-0315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0089529332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5740900001Medicare NSC