Provider Demographics
NPI:1134183700
Name:OSHIKANLU, OLABISI OYETOKUNBO (MD)
Entity type:Individual
Prefix:DR
First Name:OLABISI
Middle Name:OYETOKUNBO
Last Name:OSHIKANLU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 OLD BRICK RD
Mailing Address - Street 2:APT #1417
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5991
Mailing Address - Country:US
Mailing Address - Phone:318-581-0903
Mailing Address - Fax:
Practice Address - Street 1:2420 OLD BRICK RD
Practice Address - Street 2:APT #1417
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5991
Practice Address - Country:US
Practice Address - Phone:318-581-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD10676R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1996971Medicaid
LA5U657Medicare PIN
LA1996971Medicaid
LA5U657DD68Medicare PIN