Basic Information
| Provider Information | |||||||||
| NPI: | 1003854449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOLABI | ||||||||
| FirstName: | ISIAKA | ||||||||
| MiddleName: | OLAWALE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 381 BROAD ST APT 707A | ||||||||
| Address2: | NEWARK,NJ | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071045314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 6464171127 | ||||||||
| Practice Location | |||||||||
| Address1: | 3050 COMMERCE DR | ||||||||
| Address2: | SUITE C CREDENTIALS | ||||||||
| City: | FORT GRATIOT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480593819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103858086 | ||||||||
| FaxNumber: | 8103854933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 4301087339 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 061654 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 4301087339 | 01 | MI | PHYSICIAN LICENSE | OTHER |