Provider Demographics
NPI:1184398414
Name:KOLAWOLE, OMOLARA DASOLA (MD)
Entity type:Individual
Prefix:
First Name:OMOLARA
Middle Name:DASOLA
Last Name:KOLAWOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OMOLARA
Other - Middle Name:DASOLA
Other - Last Name:KOLAWOLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2686 MURWORTH DR APT 1116
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1614
Mailing Address - Country:US
Mailing Address - Phone:832-989-9080
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN STREET
Practice Address - Street 2:MSB 7.003
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-7703
Practice Address - Country:US
Practice Address - Phone:713-500-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100749152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology