Provider Demographics
NPI:1306046214
Name:OLABIGE, OLUTAYO T (MD)
Entity type:Individual
Prefix:
First Name:OLUTAYO
Middle Name:T
Last Name:OLABIGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 141032
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-1032
Mailing Address - Country:US
Mailing Address - Phone:646-623-8106
Mailing Address - Fax:352-581-6226
Practice Address - Street 1:6218 W CORPORATE OAKS DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8723
Practice Address - Country:US
Practice Address - Phone:352-346-3127
Practice Address - Fax:352-581-6226
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY48779207R00000X
IN01068818A207RN0300X
FLME119764207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019517200Medicaid
IN201272180Medicaid
KY7100389860Medicaid