Provider Demographics
NPI:1285958884
Name:OLAGUNJU, OLUMIDE T (MD)
Entity type:Individual
Prefix:DR
First Name:OLUMIDE
Middle Name:T
Last Name:OLAGUNJU
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 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:
Practice Address - Street 1:6355 S BUFFALO DR FL 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2133
Practice Address - Country:US
Practice Address - Phone:702-952-9171
Practice Address - Fax:702-952-9136
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13284776-1205207R00000X, 208M00000X
NV14674208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1285958884Medicaid
WAMD60329818OtherWA LIC
NV14674OtherSTATE LICENSE