Provider Demographics
NPI:1659682854
Name:OLATUNBOSUN, BAMIDELE AYOOLA (MD)
Entity type:Individual
Prefix:DR
First Name:BAMIDELE
Middle Name:AYOOLA
Last Name:OLATUNBOSUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 N 56TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4057
Mailing Address - Country:US
Mailing Address - Phone:813-422-5144
Mailing Address - Fax:
Practice Address - Street 1:10320 N 56TH ST STE 100
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-4057
Practice Address - Country:US
Practice Address - Phone:813-422-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148937207Q00000X
CAA143986207Q00000X
AK142113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine