Healthcare Provider Details

I. General information

NPI: 1811954852
Provider Name (Legal Business Name): EDILEOLA TOLULOPE MAKINDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ROAD TO SIX FLAGS W STE 116
ARLINGTON TX
76012-2615
US

IV. Provider business mailing address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

V. Phone/Fax

Practice location:
  • Phone: 817-542-0833
  • Fax: 817-542-0834
Mailing address:
  • Phone: 410-558-4888
  • Fax: 410-510-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP7154
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberPENDING
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberP7154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: