Provider Demographics
NPI:1942312814
Name:BANKOLE, OLAYINKA ABIODUN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAYINKA
Middle Name:ABIODUN
Last Name:BANKOLE
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 1:4513 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2703
Mailing Address - Country:US
Mailing Address - Phone:813-414-0825
Mailing Address - Fax:
Practice Address - Street 1:4204 B N MACDILL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6364
Practice Address - Country:US
Practice Address - Phone:813-414-0825
Practice Address - Fax:813-414-0175
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069767207R00000X
FLME69767207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379938700Medicaid
FL31792XMedicare PIN