1033465893 NPI number — IFEDOLAPO SULYMAN OLANREWAJU M.D.

Table of content: IFEDOLAPO SULYMAN OLANREWAJU M.D. (NPI 1033465893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033465893 NPI number — IFEDOLAPO SULYMAN OLANREWAJU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLANREWAJU
Provider First Name:
IFEDOLAPO
Provider Middle Name:
SULYMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033465893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 RIVERWALK BLVD
Provider Second Line Business Mailing Address:
APT 709
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71105-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-528-7946
Provider Business Mailing Address Fax Number:
318-449-2320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3330 MASONIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71301-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-487-1122
Provider Business Practice Location Address Fax Number:
318-449-2320
Provider Enumeration Date:
07/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD61378636 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD. 208226 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com