Healthcare Provider Details

I. General information

NPI: 1427246628
Provider Name (Legal Business Name): KAYODE OLOWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 JFK DR SUITE 102
ATLANTIS FL
33462-6632
US

IV. Provider business mailing address

160 JFK DR SUITE 102
ATLANTIS FL
33462-6632
US

V. Phone/Fax

Practice location:
  • Phone: 561-439-0961
  • Fax: 561-439-0963
Mailing address:
  • Phone: 561-439-0961
  • Fax: 561-439-0963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number221994
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME129999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: