Provider Demographics
NPI:1194132407
Name:OLELE, IFEANYI MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:IFEANYI
Middle Name:MICHAEL
Last Name:OLELE
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:10339 DEMOCRACY LN STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2521
Mailing Address - Country:US
Mailing Address - Phone:301-485-6468
Mailing Address - Fax:248-243-8804
Practice Address - Street 1:10339 DEMOCRACY LN STE A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2521
Practice Address - Country:US
Practice Address - Phone:301-485-6468
Practice Address - Fax:703-955-0915
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189662084P0800X
VA01022049142084P0800X
DCDO0346972084P0800X
FLOS138692084P0800X
MDH00859832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry