Provider Demographics
NPI:1558795377
Name:ESAN, OLUBUNMI OLATAYO (MD)
Entity type:Individual
Prefix:DR
First Name:OLUBUNMI
Middle Name:OLATAYO
Last Name:ESAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4300 W LAKE MARY BLVD STE 1010
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2449
Mailing Address - Country:US
Mailing Address - Phone:407-543-6411
Mailing Address - Fax:407-627-0311
Practice Address - Street 1:1355 S INTERNATIONAL PKWY STE 1491
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1694
Practice Address - Country:US
Practice Address - Phone:040-754-3641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1582412086S0129X, 2086S0129X
OH35.141595208600000X
PAMD470322208600000X
KY477472086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0454885Medicaid