Provider Demographics
NPI:1942383450
Name:FATINIKUN, OLATUNDE ORE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLATUNDE
Middle Name:ORE
Last Name:FATINIKUN
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 1:141 N OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4629
Mailing Address - Country:US
Mailing Address - Phone:813-445-5538
Mailing Address - Fax:877-576-6793
Practice Address - Street 1:141 N OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4629
Practice Address - Country:US
Practice Address - Phone:419-794-0567
Practice Address - Fax:419-794-0569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0840812084P0800X
OH350840812084P0804X
FLME1577882084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2518823Medicaid
OH35.084081OtherMEDICAL LICENSE#
FLME157788OtherMEDICAL LICENSE #
FA4141342Medicare ID - Type Unspecified
BF8745486OtherDEA REGISTRATION #