MEDICARE: DR. OLUDARE OGUNSOLA D.O.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	34.012784	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
2	OS23382	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1598911323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLUDARE OGUNSOLA D.O.

Provider Business Mailing Address
First Line	:	10380 SW VILLAGE CENTER DR STE 148
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-1931
Country	:	US
Telephone Number	:	772-266-7846
Fax Number	:	561-510-9738

Provider Business Practice Location Address
First Line	:	800 VIRGINIA AVE STE 45
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5893
Country	:	US
Telephone Number	:	740-779-4598
Fax Number	:	740-779-4599

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	05/06/2026

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Directions to “ DR. OLUDARE OGUNSOLA D.O.” Practice Location

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