Provider Demographics
NPI:1891905550
Name:OLAKUNLE D. AJANAKU, MD. PC.
Entity Type:Organization
Organization Name:OLAKUNLE D. AJANAKU, MD. PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLAKUNLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:AJANAKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-758-3536
Mailing Address - Street 1:1101 S BELMONT AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6315
Mailing Address - Country:US
Mailing Address - Phone:918-758-3536
Mailing Address - Fax:918-758-3537
Practice Address - Street 1:1101 S BELMONT AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6315
Practice Address - Country:US
Practice Address - Phone:918-758-3536
Practice Address - Fax:918-758-3537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100002630DMedicaid
OK100002630FMedicaid
OK5030315OtherAETNA
OK030662440003OtherBCBS
OK100002630DMedicaid
OK030662440Medicare PIN
OK030662440Medicare ID - Type Unspecified