Provider Demographics
NPI:1396912796
Name:OLUWATOSIN, OLUWAKUNLE OLALEKAN (MD)
Entity type:Individual
Prefix:
First Name:OLUWAKUNLE
Middle Name:OLALEKAN
Last Name:OLUWATOSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GBENGA
Other - Middle Name:LEKAN, KUNLE
Other - Last Name:OLUWATOSIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1912 ANDREA DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-6016
Mailing Address - Country:US
Mailing Address - Phone:646-316-0493
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-302-4406
Practice Address - Fax:573-302-4408
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065287A208M00000X, 207R00000X
TXV6205207RI0011X
WI51912207RC0000X
MO2020036581207RI0011X
NE30760207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease