Healthcare Provider Details

I. General information

NPI: 1356726335
Provider Name (Legal Business Name): LATEEF OLASUNKANMI LAWAL JR. DPM, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 E 41ST ST
TULSA OK
74135-2527
US

IV. Provider business mailing address

PO BOX 268838
OKLAHOMA CITY OK
73126-8838
US

V. Phone/Fax

Practice location:
  • Phone: 918-634-7500
  • Fax: 918-619-4960
Mailing address:
  • Phone: 918-634-7500
  • Fax: 918-634-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberEL6760
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL6760
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number376
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: