Provider Demographics
NPI:1306984711
Name:ODUWOLE, OLUKAYODE ADE (PA)
Entity type:Individual
Prefix:MR
First Name:OLUKAYODE
Middle Name:ADE
Last Name:ODUWOLE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:19871 NORTHBROOK DR
Mailing Address - Street 2:SUITE #203
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5053
Mailing Address - Country:US
Mailing Address - Phone:248-395-2206
Mailing Address - Fax:248-395-0456
Practice Address - Street 1:20755 GREENFIELD RD
Practice Address - Street 2:SUITE #203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5403
Practice Address - Country:US
Practice Address - Phone:248-395-2206
Practice Address - Fax:248-395-0456
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2016-05-18
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Provider Licenses
StateLicense IDTaxonomies
MI5601002421363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical