Provider Demographics
NPI:1851340517
Name:OLUFEMI, OLALEKAN PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:OLALEKAN
Middle Name:PETER
Last Name:OLUFEMI
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 1:1067 PASEO DEL RIO NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-1469
Mailing Address - Country:US
Mailing Address - Phone:727-563-0882
Mailing Address - Fax:727-577-8161
Practice Address - Street 1:1700 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE D-1
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2130
Practice Address - Country:US
Practice Address - Phone:727-669-3800
Practice Address - Fax:727-669-5600
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90831207R00000X
DEC1-0024932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2717905-00Medicaid
FL50012OtherBCBS
FL2717905-00Medicaid
FLI23785Medicare UPIN