1982743019 NPI number — OLANREWAJU ABRAHAM LANRE-KOLAWOLE R. PH

Table of content: OLANREWAJU ABRAHAM LANRE-KOLAWOLE R. PH (NPI 1982743019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982743019 NPI number — OLANREWAJU ABRAHAM LANRE-KOLAWOLE R. PH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANRE-KOLAWOLE
Provider First Name:
OLANREWAJU
Provider Middle Name:
ABRAHAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R. PH
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:
1982743019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3610 N FRENCH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85222-6625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-876-5591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
542 E HUNT HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEEN CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85243-5238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-888-1781
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2007

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: 183500000X , with the licence number:  14624 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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