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General NPI Number Information
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NPI Number | 1184398414
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Entity Type | Individual
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Provider Name | OMOLARA DASOLA KOLAWOLE MD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 6431 FANNIN STREET MSB 7.003
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City | HOUSTON
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State | TX
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Zip | 77030-7703
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Country | US
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Telephone | 713-500-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 2686 MURWORTH DR APT 1116
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City | HOUSTON
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State | TX
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Zip | 77054-1614
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Country | US
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Telephone | 832-989-9080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | BP10074915
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License Number State | TX
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