Provider Demographics
NPI:1841236320
Name:IDOWU, OLAJIRE (MD)
Entity Type:Individual
Prefix:
First Name:OLAJIRE
Middle Name:
Last Name:IDOWU
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 1:744 52ND ST
Mailing Address - Street 2:4100
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1810
Mailing Address - Country:US
Mailing Address - Phone:510-547-1600
Mailing Address - Fax:510-428-3405
Practice Address - Street 1:744 52ND ST
Practice Address - Street 2:4100
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1810
Practice Address - Country:US
Practice Address - Phone:510-547-1600
Practice Address - Fax:510-428-3405
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA333452086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A33450Medicaid