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General NPI Number Information
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NPI Number | 1235387416
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Entity Type | Individual
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Provider Name | OLUSEGUN ADESANYA ODUKOYA M.D
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Gender | Male
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Dates
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Enumeration Date | 08/30/2008
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-3944
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Fax | 216-844-8974
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Provider Business Mailing Address
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Address Line | 24701 EUCLID AVE 3RD FLOOR
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City | EUCLID
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State | OH
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Zip | 44117-1714
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Country | US
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Telephone |
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | TP891
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 4301093350
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 35.120134
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License Number State | OH
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