Healthcare Provider Details

I. General information

NPI: 1902668338
Provider Name (Legal Business Name): OLAYEMI OLABADE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PARK AVE
SAINT LOUIS MO
63104-3024
US

IV. Provider business mailing address

10 BEL RAE CT APT 304A
SAINT CHARLES MO
63301-5897
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-2700
  • Fax:
Mailing address:
  • Phone: 314-313-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: