Provider Demographics
NPI:1861087769
Name:OLATEJU, MICHAEL AYOWOLE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:AYOWOLE
Last Name:OLATEJU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 MAGDALENE LN APT B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-8026
Mailing Address - Country:US
Mailing Address - Phone:317-341-5703
Mailing Address - Fax:
Practice Address - Street 1:614 MAGDALENE LN APT B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-8026
Practice Address - Country:US
Practice Address - Phone:317-341-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty