Provider Demographics
NPI:1619841830
Name:OJO, OLAYIWOLA
Entity type:Individual
Prefix:
First Name:OLAYIWOLA
Middle Name:
Last Name:OJO
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 1:6849 WOODWARD WAY
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-8588
Mailing Address - Country:US
Mailing Address - Phone:317-640-0242
Mailing Address - Fax:
Practice Address - Street 1:6849 WOODWARD WAY
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-8588
Practice Address - Country:US
Practice Address - Phone:317-640-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN250189231376J00000X, 3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty