Healthcare Provider Details

I. General information

NPI: 1316804115
Provider Name (Legal Business Name): ADEDAPO OLOSUNDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 ENCORE CIR UNIT 252
MAUMEE OH
43537-7811
US

IV. Provider business mailing address

6800 ENCORE CIR
MAUMEE OH
43537-7802
US

V. Phone/Fax

Practice location:
  • Phone: 419-936-8509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberVG526200
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: