Provider Demographics
NPI:1689189771
Name:OLATUNJI, ADEMOLA (MD)
Entity Type:Individual
Prefix:
First Name:ADEMOLA
Middle Name:
Last Name:OLATUNJI
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 1:809 RODNEY AVE
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2438
Mailing Address - Country:US
Mailing Address - Phone:254-577-5547
Mailing Address - Fax:
Practice Address - Street 1:809 RODNEY AVE
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2438
Practice Address - Country:US
Practice Address - Phone:254-577-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility