Healthcare Provider Details

I. General information

NPI: 1275882599
Provider Name (Legal Business Name): OLIVER EZEKIEL AREGULLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OLIVER EZEKIEL AREGULLIN MD

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 N LAKE CREEK PKWY
AUSTIN TX
78717-6210
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 737-229-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberU8939
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301112330
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number110254
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberU8939
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301112330
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code207RA0002X
TaxonomyAdult Congenital Heart Disease Physician
License Number4301112330
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: