Provider Demographics
NPI:1386804466
Name:OWOLABI, MICHAEL S (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:OWOLABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-3836
Mailing Address - Country:US
Mailing Address - Phone:830-876-9625
Mailing Address - Fax:830-876-5752
Practice Address - Street 1:706 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CARRIZO SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78834-3836
Practice Address - Country:US
Practice Address - Phone:830-876-9625
Practice Address - Fax:830-876-5752
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8963207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285802901Medicaid
TX285802901Medicaid