=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467634782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLALEKAM ADIGUM M SORUMKE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2007
-----------------------------------------------------
Last Update Date | 12/04/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10935 ESTATE LN SUITE 274
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-553-2544
-----------------------------------------------------
Fax | 214-503-0315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10935 ESTATE LN SUITE 274
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-553-2544
-----------------------------------------------------
Fax | 214-503-0315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OLALEKAM ADIGUM SORUMKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-553-2544
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0089529
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------