Provider Demographics
NPI:1932177144
Name:OLUWOLE, OLAKUNLE KAYODE (MD)
Entity type:Individual
Prefix:DR
First Name:OLAKUNLE
Middle Name:KAYODE
Last Name:OLUWOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:379 OLD TAPPAN RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6806
Mailing Address - Country:US
Mailing Address - Phone:201-681-9700
Mailing Address - Fax:201-681-9700
Practice Address - Street 1:379 OLD TAPPAN RD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675-6806
Practice Address - Country:US
Practice Address - Phone:631-581-4400
Practice Address - Fax:631-277-3750
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07993500208600000X
PAMD428526208600000X
CT047735208600000X
NY212153208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery