Healthcare Provider Details

I. General information

NPI: 1679968903
Provider Name (Legal Business Name): OLAWALE AYODELE ONIBILE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13025 8TH ST
OSSEO WI
54758-7634
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 715-597-2575
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number68853
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: