Healthcare Provider Details

I. General information

NPI: 1013210459
Provider Name (Legal Business Name): OLUFUNSHO ADAMOLEKUN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FIRSTVILLAGE DRIVE
PINEHURST NC
28374
US

IV. Provider business mailing address

1814 E INDIANA AVE
SOUTHERN PINES NC
28387-7224
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-6831
  • Fax: 910-295-0244
Mailing address:
  • Phone: 919-412-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number91325
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number101136
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number201801995
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34.011377
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: