Provider Demographics
NPI:1710279534
Name:OJELADE, MICHAEL IDOWU (APN)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:IDOWU
Last Name:OJELADE
Suffix:
Gender:M
Credentials:APN
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:OJELADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:67 BOBOLINK CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8450
Mailing Address - Country:US
Mailing Address - Phone:973-953-3643
Mailing Address - Fax:
Practice Address - Street 1:67 BOBOLINK CT
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8450
Practice Address - Country:US
Practice Address - Phone:973-953-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00108700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health