Provider Demographics
NPI:1013658038
Name:OJO, BOLAJI SOJI
Entity Type:Individual
Prefix:
First Name:BOLAJI
Middle Name:SOJI
Last Name:OJO
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 1:7210 VILLAGE PARKWAY DR APT 5
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4352
Mailing Address - Country:US
Mailing Address - Phone:317-285-9081
Mailing Address - Fax:
Practice Address - Street 1:727 MOON RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-8757
Practice Address - Country:US
Practice Address - Phone:317-839-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF02220900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily