Provider Demographics
NPI:1760739841
Name:TATA-OYEKAN, DOROTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:TATA-OYEKAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:TATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:12903 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1538
Practice Address - Country:US
Practice Address - Phone:502-245-4301
Practice Address - Fax:502-244-5829
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29385207Q00000X
FLME110928207Q00000X
KY46953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine