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General NPI Number Information
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NPI Number | 1902465073
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Entity Type | Individual
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Provider Name | OMOLARA LAWAL MD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1821 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-2253
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19070
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City | GREEN BAY
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State | WI
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Zip | 54307-9070
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Country | US
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Telephone | 920-496-4700
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MT218172
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MT218172
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 83923-20
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License Number State | WI
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