Provider Demographics
NPI:1881819365
Name:OWI, ENIOLA ADEYEMI (MD)
Entity type:Individual
Prefix:
First Name:ENIOLA
Middle Name:ADEYEMI
Last Name:OWI
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 1:607 W. DR. M. L. KING JR BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3453
Mailing Address - Country:US
Mailing Address - Phone:813-238-1222
Mailing Address - Fax:813-238-1214
Practice Address - Street 1:607 W. DR. M. L. KING JR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3453
Practice Address - Country:US
Practice Address - Phone:813-238-1222
Practice Address - Fax:813-238-1214
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 635362083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine