Provider Demographics
NPI:1316645013
Name:OLORUNLEKE, OLUWASEUN EMMANUEL
Entity type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:EMMANUEL
Last Name:OLORUNLEKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:OLUWASEUN
Other - Middle Name:EMMANUEL
Other - Last Name:JOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8465 WHITE CEDAR DR APT 832
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5356
Mailing Address - Country:US
Mailing Address - Phone:937-475-7428
Mailing Address - Fax:
Practice Address - Street 1:8465 WHITE CEDAR DR APT 832
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5356
Practice Address - Country:US
Practice Address - Phone:937-475-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHXS4314347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH347C00000XMedicaid