Provider Demographics
NPI:1316638190
Name:OLUDIRAN, FUNMILAYO ROLAKE (MD)
Entity type:Individual
Prefix:
First Name:FUNMILAYO
Middle Name:ROLAKE
Last Name:OLUDIRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARKVIEW MEDICAL CENTER EIN#840935136
Mailing Address - Street 2:400 W 16TH STREET GRADUATE MEDICAL EDUCATION OFFICE
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003
Mailing Address - Country:US
Mailing Address - Phone:719-595-7585
Mailing Address - Fax:719-595-7589
Practice Address - Street 1:PARKVIEW ADULT MEDICINE CLINIC
Practice Address - Street 2:311 WEST 14TH STREET
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-595-7585
Practice Address - Fax:719-595-7589
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program