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General NPI Number Information
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NPI Number | 1538182936
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Entity Type | Individual
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Provider Name | OLADIMEJI OLU SORUNKE PA
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 2500 W PLEASANT RUN RD STE 215
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City | LANCASTER
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State | TX
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Zip | 75146-1170
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Country | US
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Telephone | 214-208-9883
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Fax | 972-223-7688
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Provider Business Mailing Address
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Address Line | PO BOX 2022
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City | MANSFIELD
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State | TX
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Zip | 76063-0019
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Country | US
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Telephone | 817-723-3638
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA03163
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License Number State | TX
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