Healthcare Provider Details

I. General information

NPI: 1487888301
Provider Name (Legal Business Name): MR. GABRIEL OLUFEMI OLOWU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 CROSS COURTS DR
GARLAND TX
75040-7535
US

IV. Provider business mailing address

1421 CROSS COURTS DR
GARLAND TX
75040-7535
US

V. Phone/Fax

Practice location:
  • Phone: 312-213-7232
  • Fax: 972-422-2518
Mailing address:
  • Phone: 312-213-7232
  • Fax: 972-422-2518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: