Provider Demographics
NPI:1134708027
Name:LANASE-SALAAM, MOTUNRAYO ADEBIMPE (MD)
Entity type:Individual
Prefix:
First Name:MOTUNRAYO
Middle Name:ADEBIMPE
Last Name:LANASE-SALAAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOTUNRAYO
Other - Middle Name:ADEBIMPE
Other - Last Name:LANASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 S SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5440
Mailing Address - Country:US
Mailing Address - Phone:918-619-4600
Mailing Address - Fax:918-619-4696
Practice Address - Street 1:1005 DR DB TODD JR BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3501
Practice Address - Country:US
Practice Address - Phone:615-327-6782
Practice Address - Fax:615-327-6131
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38314390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program