Healthcare Provider Details

I. General information

NPI: 1407054331
Provider Name (Legal Business Name): OLUDAMILOLA O OGUNLESI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 RICHMOND RD
BEACHWOOD OH
44122-6046
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 216-593-5500
  • Fax: 216-593-5544
Mailing address:
  • Phone: 216-593-5500
  • Fax: 216-593-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37124
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.088302
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: