Healthcare Provider Details

I. General information

NPI: 1295990588
Provider Name (Legal Business Name): ABIMBOLA O. OLOWO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17855 DALLAS PKWY STE 200
DALLAS TX
75287-6857
US

IV. Provider business mailing address

408 JANET CT
NEW CASTLE DE
19720-5628
US

V. Phone/Fax

Practice location:
  • Phone: 909-340-2229
  • Fax: 909-331-4801
Mailing address:
  • Phone: 302-897-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0079914
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0009038
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: