Provider Demographics
NPI:1891480539
Name:OLUWADARE, JIDE KOLADE OLUWADAMILOLA (MD)
Entity Type:Individual
Prefix:
First Name:JIDE
Middle Name:KOLADE OLUWADAMILOLA
Last Name:OLUWADARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BABAJIDE
Other - Middle Name:K
Other - Last Name:OLUWADARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6018 POMERANIA CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6515
Mailing Address - Country:US
Mailing Address - Phone:770-634-3758
Mailing Address - Fax:
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program