Healthcare Provider Details

I. General information

NPI: 1568024685
Provider Name (Legal Business Name): OLAYINKA OLUBUKOLA OKELEJI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLAYINKA OLUBUKOLA ODETOLA MD

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOLCOMBE BLVD, DEPARTMENT OF PEDIATRICS
HOUSTON TX
77030
US

IV. Provider business mailing address

1515 HOLCOMBE BLVD
HOUSTON TX
77030-4000
US

V. Phone/Fax

Practice location:
  • Phone: 844-510-2546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberU0169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: