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General NPI Number Information
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NPI Number | 1558795377
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Entity Type | Individual
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Provider Name | OLUBUNMI OLATAYO ESAN M.D
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Gender | Male
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1355 S INTERNATIONAL PKWY STE 1491
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City | LAKE MARY
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State | FL
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Zip | 32746-1694
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Country | US
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Telephone | 40-754-3641
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 W LAKE MARY BLVD STE 1010
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City | LAKE MARY
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State | FL
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Zip | 32746-2449
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Country | US
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Telephone | 407-543-6411
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Fax | 407-627-0311
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME158241
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License Number State | FL
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