Healthcare Provider Details

I. General information

NPI: 1841236320
Provider Name (Legal Business Name): OLAJIRE IDOWU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 52ND ST 4100
OAKLAND CA
94609-1810
US

IV. Provider business mailing address

744 52ND ST 4100
OAKLAND CA
94609-1810
US

V. Phone/Fax

Practice location:
  • Phone: 510-547-1600
  • Fax: 510-428-3405
Mailing address:
  • Phone: 510-547-1600
  • Fax: 510-428-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA33345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: