Provider Demographics
NPI:1639313364
Name:OLUTUNMBI, YETUNDE O (MD)
Entity type:Individual
Prefix:
First Name:YETUNDE
Middle Name:O
Last Name:OLUTUNMBI
Suffix:
Gender:F
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:PO BOX 826515
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6515
Mailing Address - Country:US
Mailing Address - Phone:888-733-7271
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:3023 MONTCLAIR CIR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3796
Practice Address - Country:US
Practice Address - Phone:716-807-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-157618207L00000X
GA81916207L00000X
PAMD450720207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology