Healthcare Provider Details

I. General information

NPI: 1689089658
Provider Name (Legal Business Name): OLADAPO OSHIKOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/04/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY # U-11
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

1924 ALCOA HWY # U-11
KNOXVILLE TN
37920-1511
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9230
  • Fax: 865-305-8894
Mailing address:
  • Phone: 865-305-9230
  • Fax: 865-305-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME149950
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: