Provider Demographics
NPI:1609538016
Name:OLUBUKOLA, OLUFUNMILOLA ABIODUN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUFUNMILOLA
Middle Name:ABIODUN
Last Name:OLUBUKOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLUFUNMILOLA
Other - Middle Name:ABIODUN
Other - Last Name:OLUBUKOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:497-286-4515
Practice Address - Street 1:1502 VILLAGE OAK LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6558
Practice Address - Country:US
Practice Address - Phone:407-627-0066
Practice Address - Fax:407-440-4054
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTBAJLDM-15-940I208M00000X
FLACN1496208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist