Provider Demographics
NPI:1144304346
Name:OLADUTE, OLUWOLE E (MD, PHD,)
Entity type:Individual
Prefix:
First Name:OLUWOLE
Middle Name:E
Last Name:OLADUTE
Suffix:
Gender:M
Credentials:MD, PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1674
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-1674
Mailing Address - Country:US
Mailing Address - Phone:281-238-5480
Mailing Address - Fax:832-595-9796
Practice Address - Street 1:306 LAKEGLEN CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3986
Practice Address - Country:US
Practice Address - Phone:281-238-5480
Practice Address - Fax:832-595-9796
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0170207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045EEOtherBCBS OF TEXAS
TX140304004Medicaid
TX140304004Medicaid
TX00U58YMedicare PIN