Provider Demographics
NPI:1912011255
Name:OLAGBEGI, OLAYIWOLA C (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAYIWOLA
Middle Name:C
Last Name:OLAGBEGI
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 1:11155 DUNN RD STE 309E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6111
Mailing Address - Country:US
Mailing Address - Phone:314-953-8799
Mailing Address - Fax:
Practice Address - Street 1:11155 DUNN RD STE 309E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6111
Practice Address - Country:US
Practice Address - Phone:314-953-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099505207RG0100X
MO114046207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100011347OtherMEDICARE RAILROAD
MO209698901Medicaid
MO001013714Medicare ID - Type UnspecifiedCPIN
MO209698901Medicaid