Healthcare Provider Details

I. General information

NPI: 1124217393
Provider Name (Legal Business Name): YETUNDE O. OLOJO M.ED; FAODP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37740 HILLCREST DR
WAYNE MI
48184-1056
US

IV. Provider business mailing address

37740 HILLCREST DRIVE
WAYNE MI
48184
US

V. Phone/Fax

Practice location:
  • Phone: 313-377-2443
  • Fax:
Mailing address:
  • Phone: 313-377-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: