Provider Demographics
NPI:1568036804
Name:OLUTOLA, OLAYIWOLA OLUWASEUN (MD)
Entity type:Individual
Prefix:DR
First Name:OLAYIWOLA
Middle Name:OLUWASEUN
Last Name:OLUTOLA
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 1:7364 ANTOINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-7230
Mailing Address - Country:US
Mailing Address - Phone:713-486-7350
Mailing Address - Fax:
Practice Address - Street 1:7364 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-7230
Practice Address - Country:US
Practice Address - Phone:713-486-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV2802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine