Healthcare Provider Details

I. General information

NPI: 1336670330
Provider Name (Legal Business Name): OLOLADE OLUWAKEMI OGUNDELE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLOLADE OLUWAKEMI OGUNDIMU MD

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-7000
  • Fax: 832-524-5242
Mailing address:
  • Phone: 469-291-3369
  • Fax: 469-645-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberU0411
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberU0411
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: