Healthcare Provider Details

I. General information

NPI: 1275858615
Provider Name (Legal Business Name): OLUWAKEMI O OGUNDIPE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLUKEMI F OGUNDIPE MD

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 ALMEDA RD APT 442
HOUSTON TX
77021-1100
US

IV. Provider business mailing address

6301 ALMEDA RD APT 442
HOUSTON TX
77021-1100
US

V. Phone/Fax

Practice location:
  • Phone: 704-517-4916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: