Provider Demographics
NPI:1568508448
Name:SOYINKA, OLUFEMI E (MD)
Entity Type:Individual
Prefix:
First Name:OLUFEMI
Middle Name:E
Last Name:SOYINKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 NUCKOLLS RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1599
Mailing Address - Country:US
Mailing Address - Phone:731-658-3388
Mailing Address - Fax:731-658-4079
Practice Address - Street 1:629 NUCKOLLS RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1599
Practice Address - Country:US
Practice Address - Phone:731-658-3388
Practice Address - Fax:731-658-4079
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00684728OtherRR MEDICARE
TN4186909OtherBCBS
TN30004592Medicaid
TN30004592Medicaid