Provider Demographics
NPI:1699929307
Name:MICHAEL O. OLATUNJI, M.D., P.A.
Entity type:Organization
Organization Name:MICHAEL O. OLATUNJI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLANTUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-995-6244
Mailing Address - Street 1:12031 ASHAWAY LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6996
Mailing Address - Country:US
Mailing Address - Phone:214-995-6244
Mailing Address - Fax:972-216-9580
Practice Address - Street 1:12031 ASHAWAY LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6996
Practice Address - Country:US
Practice Address - Phone:214-995-6244
Practice Address - Fax:972-216-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty