Provider Demographics
NPI:1891490090
Name:ONIYIDE, OLUSEYE DANDANNIRE
Entity Type:Individual
Prefix:
First Name:OLUSEYE
Middle Name:DANDANNIRE
Last Name:ONIYIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SOUTHWEST FWY APT 554
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7457
Mailing Address - Country:US
Mailing Address - Phone:346-772-6123
Mailing Address - Fax:
Practice Address - Street 1:4100 SOUTHWEST FWY APT 554
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7457
Practice Address - Country:US
Practice Address - Phone:346-772-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.254595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine