Provider Demographics
NPI:1578023347
Name:OLUTOGE, FREDRICK AKINKUNLE
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:AKINKUNLE
Last Name:OLUTOGE
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 1:3202 RAMBLEWOOD CIR APT 1014
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-4571
Mailing Address - Country:US
Mailing Address - Phone:469-237-8902
Mailing Address - Fax:
Practice Address - Street 1:3202 RAMBLEWOOD CIR APT 1014
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4571
Practice Address - Country:US
Practice Address - Phone:469-237-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)