Provider Demographics
NPI:1770783748
Name:OLOWE, OLUSOLA AKINTUNDE (MD)
Entity type:Individual
Prefix:MR
First Name:OLUSOLA
Middle Name:AKINTUNDE
Last Name:OLOWE
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 1:10176 W 400 N STE C
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9009
Mailing Address - Country:US
Mailing Address - Phone:219-873-1777
Mailing Address - Fax:219-873-0001
Practice Address - Street 1:10176 W 400 N STE C
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9009
Practice Address - Country:US
Practice Address - Phone:219-873-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067735A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation