Provider Demographics
NPI:1427246628
Name:OLOWE, KAYODE (MD)
Entity type:Individual
Prefix:DR
First Name:KAYODE
Middle Name:
Last Name:OLOWE
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 1:160 JFK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6632
Mailing Address - Country:US
Mailing Address - Phone:561-439-0961
Mailing Address - Fax:561-439-0963
Practice Address - Street 1:160 JFK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6632
Practice Address - Country:US
Practice Address - Phone:561-439-0961
Practice Address - Fax:561-439-0963
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221994207RG0100X, 207RG0100X
FLME129999207RG0100X
OH35084239207RG0100X
NJ25MA08586800207RG0100X
WAMD00049458207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8519969Medicaid
NY02471992Medicaid
H99869Medicare UPIN
WA8519969Medicaid
200AG1Medicare PIN