Healthcare Provider Details

I. General information

NPI: 1487643599
Provider Name (Legal Business Name): OLAKUNLE O TAIWO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S CENTER ST
GROVE CITY PA
16127-1507
US

IV. Provider business mailing address

1699 WASHINGTON RD SUITE 307
PITTSBURGH PA
15228-1629
US

V. Phone/Fax

Practice location:
  • Phone: 724-264-4303
  • Fax: 724-264-4305
Mailing address:
  • Phone: 412-831-3744
  • Fax: 412-831-5663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD067051L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: