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General NPI Number Information
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NPI Number | 1194849901
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Entity Type | Individual
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Provider Name | OLUSOLA OGUNDIPE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 2600 ROOSEVELT RD
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City | VALPARAISO
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State | IN
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Zip | 46383-0970
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Country | US
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Telephone | 219-464-1620
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Fax | 219-477-4565
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Provider Business Mailing Address
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Address Line | 342 E 109TH AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-8693
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Country | US
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Telephone | 219-310-2550
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 10165962A
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License Number State | IN
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