MEDICARE: TOYOSI IKEADE OMOLE NP

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	208D00000X	General Practice Physician	1032791	TX

General Provider Information

NPI Number	:	1326905720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOYOSI IKEADE OMOLE NP

Provider Business Mailing Address
First Line	:	873 S STEMMONS FWY # 100
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-5351
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	873 S STEMMONS FWY # 100
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-5351
Country	:	US
Telephone Number	:	214-377-0541
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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Directions to “ TOYOSI IKEADE OMOLE NP” Practice Location

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