Healthcare Provider Details

I. General information

NPI: 1154907749
Provider Name (Legal Business Name): MILLICENT ADEOLA OLAWALE MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4226
US

IV. Provider business mailing address

1959 NE PACIFIC ST
SEATTLE WA
98195-1437
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-7890
  • Fax:
Mailing address:
  • Phone: 206-543-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2025-02587
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: