Healthcare Provider Details

I. General information

NPI: 1336634187
Provider Name (Legal Business Name): OLUSUNMISOLA OYERONKE OYESIKU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 MULBERRY ST
MONTGOMERY AL
36106-1163
US

IV. Provider business mailing address

1329 MULBERRY ST
MONTGOMERY AL
36106-1163
US

V. Phone/Fax

Practice location:
  • Phone: 334-245-9780
  • Fax: 949-666-2213
Mailing address:
  • Phone: 334-245-9780
  • Fax: 949-666-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42855
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: