MEDICARE: JACQUELINE NWANDO OLAYIWOLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35137342	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073510103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE NWANDO OLAYIWOLA MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-688-6490
Fax Number	:	614-688-6491

Provider Business Practice Location Address
First Line	:	543 TAYLOR AVE FL 2
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1278
Country	:	US
Telephone Number	:	614-688-6490
Fax Number	:	614-688-6491

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	10/09/2019

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