Provider Demographics
NPI:1780207340
Name:OLU-LAWAL, TOLULOPE JOSHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:TOLULOPE
Middle Name:JOSHUA
Last Name:OLU-LAWAL
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 1:1947 W BIRCHWOOD AVE APT 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1571
Mailing Address - Country:US
Mailing Address - Phone:312-613-2940
Mailing Address - Fax:
Practice Address - Street 1:1947 W BIRCHWOOD AVE APT 3W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1571
Practice Address - Country:US
Practice Address - Phone:312-613-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036164693207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program