Basic Information
| Provider Information | |||||||||
| NPI: | 1639497779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLADE | ||||||||
| FirstName: | OLUSOLA | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 MEDICAL CENTER PKWY | ||||||||
| Address2: | HOSPITALIST OFFICE | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153964694 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 MEDICAL CENTER PKWY | ||||||||
| Address2: | HOSPITALIST OFFICE | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153964694 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2010 | ||||||||
| LastUpdateDate: | 03/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 53932 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD2014-0710 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.