Provider Demographics
NPI:1104673052
Name:OMOSULE, MICHAEL OLUWASEUN (MBBS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OLUWASEUN
Last Name:OMOSULE
Suffix:
Gender:
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 EAST UNIVERSITY PARKWAY, 33RD ST. BUILDING
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:443-621-9055
Mailing Address - Fax:
Practice Address - Street 1:201 EAST UNIVERSITY PARKWAY, 33RD ST. BUILDING
Practice Address - Street 2:SUITE 405
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:443-621-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program