Provider Demographics
NPI:1598911323
Name:OGUNSOLA, OLUDARE (DO)
Entity Type:Individual
Prefix:DR
First Name:OLUDARE
Middle Name:
Last Name:OGUNSOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DARE
Other - Middle Name:
Other - Last Name:OGUNSOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:272 HOSPITAL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-4222
Mailing Address - Fax:740-779-4257
Practice Address - Street 1:4437 STATE ROUTE 159 STE G15
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7065
Practice Address - Country:US
Practice Address - Phone:740-779-4598
Practice Address - Fax:740-779-4599
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012784207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0218810Medicaid