Healthcare Provider Details

I. General information

NPI: 1487371522
Provider Name (Legal Business Name): OWOLABI JR. HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 WILLIAMS TRACE BLVD STE 106
SUGAR LAND TX
77478-4443
US

IV. Provider business mailing address

1519 TYLER POINT LN
PEARLAND TX
77089-1453
US

V. Phone/Fax

Practice location:
  • Phone: 281-891-3668
  • Fax:
Mailing address:
  • Phone: 832-515-9249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS ADEKUNLE OWOLABI JR.
Title or Position: MANAGING MEMBER
Credential: DPM
Phone: 832-515-9249