Provider Demographics
NPI:1568731776
Name:KOMOLAFE, MICHAEL OLANIYI (CRT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:OLANIYI
Last Name:KOMOLAFE
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 LAKE REDMAN CT
Mailing Address - Street 2:
Mailing Address - City:SEVEN VALLEYS
Mailing Address - State:PA
Mailing Address - Zip Code:17360-9185
Mailing Address - Country:US
Mailing Address - Phone:443-608-1271
Mailing Address - Fax:
Practice Address - Street 1:592 LAKE REDMAN CT
Practice Address - Street 2:
Practice Address - City:SEVEN VALLEYS
Practice Address - State:PA
Practice Address - Zip Code:17360-9185
Practice Address - Country:US
Practice Address - Phone:443-608-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAYM013685227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified