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General NPI Number Information
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NPI Number | 1649845074
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Entity Type | Individual
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Provider Name | KUDIRAT BUKOLA OLATUNDE MD
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Gender | Female
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 333 PINE RIDGE BLVD
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City | WAUSAU
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State | WI
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Zip | 54401-4187
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Country | US
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Telephone | 800-283-2881
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Fax |
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Provider Business Mailing Address
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Address Line | 5556 OAKWOOD AVE
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City | STEVENS POINT
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State | WI
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Zip | 54482-9164
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Country | US
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Telephone | 708-539-3715
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0116035037
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 83596-20
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License Number State | WI
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