MEDICARE: OLUYEMISI OLUWOLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	296717052	TX

General Provider Information

NPI Number	:	1063735199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUYEMISI OLUWOLE

Provider Business Mailing Address
First Line	:	5900 BAYWATER DR
Second Line	:	APT 2803
City	:	PLANO
State	:	TX
Zip	:	75093-5724
Country	:	US
Telephone Number	:	469-865-0789
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 BAYWATER DR
Second Line	:	APT 2803
City	:	PLANO
State	:	TX
Zip	:	75093-5724
Country	:	US
Telephone Number	:	469-865-0789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2010
Last Update Date	:	03/03/2010

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Directions to “ OLUYEMISI OLUWOLE ” Practice Location

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