Provider Demographics
NPI:1669455929
Name:OJUTIKU, OLUKAYODE OLUJARE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUKAYODE
Middle Name:OLUJARE
Last Name:OJUTIKU
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 1:141 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6331
Mailing Address - Country:US
Mailing Address - Phone:516-538-4760
Mailing Address - Fax:516-538-8333
Practice Address - Street 1:141 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6331
Practice Address - Country:US
Practice Address - Phone:516-538-4760
Practice Address - Fax:516-538-8333
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01232104Medicaid
NY01232104Medicaid
E70748Medicare UPIN