Provider Demographics
NPI:1528612009
Name:OLATUNDE, JOHN A
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:OLATUNDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22124 W BRANDON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3833
Mailing Address - Country:US
Mailing Address - Phone:248-747-2230
Mailing Address - Fax:
Practice Address - Street 1:22124 W BRANDON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3833
Practice Address - Country:US
Practice Address - Phone:248-747-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0435429078275OtherDRIVER LICENSE