Provider Demographics
NPI:1699941435
Name:OLOWE, OLUKAYODE (MD PHD)
Entity type:Individual
Prefix:DR
First Name:OLUKAYODE
Middle Name:
Last Name:OLOWE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 EAST 103RD STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2713
Mailing Address - Country:US
Mailing Address - Phone:773-660-1635
Mailing Address - Fax:773-660-1638
Practice Address - Street 1:123 EAST 103RD STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2713
Practice Address - Country:US
Practice Address - Phone:773-660-1635
Practice Address - Fax:773-660-1638
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047948A207Q00000X
IL036094159207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094159Medicaid
G49682Medicare UPIN
247470Medicare PIN