Provider Demographics
NPI:1730132341
Name:OYESANYA, OLUSOJI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSOJI
Middle Name:
Last Name:OYESANYA
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 1:6001 W CENTER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2154
Mailing Address - Country:US
Mailing Address - Phone:414-444-4484
Mailing Address - Fax:414-444-4838
Practice Address - Street 1:6001 W CENTER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2154
Practice Address - Country:US
Practice Address - Phone:414-444-4484
Practice Address - Fax:414-444-4838
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30809207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31592300Medicaid
WIF96835Medicare UPIN
WI000073793Medicare ID - Type Unspecified