Provider Demographics
NPI:1710033386
Name:OLUWOLE, BABALOLA OLUSOLA (MD)
Entity Type:Individual
Prefix:
First Name:BABALOLA
Middle Name:OLUSOLA
Last Name:OLUWOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18207 SWEET JASMINE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2863
Mailing Address - Country:US
Mailing Address - Phone:813-300-4035
Mailing Address - Fax:877-860-6213
Practice Address - Street 1:1010 S EDMONDS LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4418
Practice Address - Country:US
Practice Address - Phone:972-829-0098
Practice Address - Fax:972-436-0145
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL742122083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI35274Medicare UPIN