Provider Demographics
NPI:1700197530
Name:EMEREUWAONU, OLUWAYEMISI (MD)
Entity Type:Individual
Prefix:
First Name:OLUWAYEMISI
Middle Name:
Last Name:EMEREUWAONU
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 1:877 JEFERSON AVENUE
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-545-6286
Mailing Address - Fax:901-545-8122
Practice Address - Street 1:2500 PERES AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38108-1660
Practice Address - Country:US
Practice Address - Phone:901-515-5400
Practice Address - Fax:901-515-4599
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.055268208000000X
AZ45333208000000X
TN49479208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics