Provider Demographics
NPI:1881381507
Name:EKUNDAYO, OLUSEGUN PAUL
Entity type:Individual
Prefix:
First Name:OLUSEGUN
Middle Name:PAUL
Last Name:EKUNDAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 LAKEVIEW DR APT D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-7750
Mailing Address - Country:US
Mailing Address - Phone:317-603-7994
Mailing Address - Fax:
Practice Address - Street 1:6211 LAKEVIEW DR APT D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-7750
Practice Address - Country:US
Practice Address - Phone:317-603-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant