Healthcare Provider Details

I. General information

NPI: 1124375985
Provider Name (Legal Business Name): ADEOLA OLOWU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2121 HEPBURN ST APT 815
HOUSTON TX
77054-3220
US

IV. Provider business mailing address

2121 HEPBURN ST APT 815
HOUSTON TX
77054-3220
US

V. Phone/Fax

Practice location:
  • Phone: 713-206-7822
  • Fax:
Mailing address:
  • Phone: 713-206-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number39
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: