Healthcare Provider Details

I. General information

NPI: 1114459690
Provider Name (Legal Business Name): JOSEPH OLOYEDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 NORTHFIELD RD STE A
BEDFORD HEIGHTS OH
44146-1101
US

IV. Provider business mailing address

8225 NORTHFIELD RD STE A
BEDFORD HEIGHTS OH
44146
US

V. Phone/Fax

Practice location:
  • Phone: 216-510-5481
  • Fax: 216-510-5427
Mailing address:
  • Phone: 216-510-5481
  • Fax: 216-510-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: