Provider Demographics
NPI:1356536627
Name:FUNMILAYO OLADUN
Entity type:Organization
Organization Name:FUNMILAYO OLADUN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-709-0808
Mailing Address - Street 1:7125 MARVIN D LOVE FWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3175
Mailing Address - Country:US
Mailing Address - Phone:972-709-0808
Mailing Address - Fax:972-709-7244
Practice Address - Street 1:7125 MARVIN D LOVE FWY
Practice Address - Street 2:SUITE 302
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3175
Practice Address - Country:US
Practice Address - Phone:972-709-0808
Practice Address - Fax:972-709-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32012163203332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193471301Medicaid
TX193471302Medicaid
TX193471301Medicaid