Provider Demographics
NPI:1194250985
Name:OMONIYI, ELIZABETH OMOJASOLA (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OMOJASOLA
Last Name:OMONIYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:520 N MONTE VISTA ST STE A
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4674
Mailing Address - Country:US
Mailing Address - Phone:580-453-3545
Mailing Address - Fax:580-453-3546
Practice Address - Street 1:520 N MONTE VISTA ST STE A
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4674
Practice Address - Country:US
Practice Address - Phone:580-453-3545
Practice Address - Fax:580-453-3546
Is Sole Proprietor?:No
Enumeration Date:2017-04-29
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK39067207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism