Provider Demographics
NPI:1679736862
Name:OLUYEMI, ENIOLA TINUOLA (MD)
Entity Type:Individual
Prefix:
First Name:ENIOLA
Middle Name:TINUOLA
Last Name:OLUYEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ENIOLA
Other - Middle Name:TINUOLA
Other - Last Name:FALOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10755 FALLS RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4515
Mailing Address - Country:US
Mailing Address - Phone:410-583-2703
Mailing Address - Fax:
Practice Address - Street 1:825 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4405
Practice Address - Country:US
Practice Address - Phone:206-288-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603317582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1679736862Medicaid
WA8918323Medicare PIN