Basic Information
| Provider Information | |||||||||
| NPI: | 1720375637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLAREWAJU | ||||||||
| FirstName: | TEMITOPE | ||||||||
| MiddleName: | OLUWATOSIN | ||||||||
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| OtherLastName: | ADEBISI | ||||||||
| OtherFirstName: | TOPE | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17 MAIN ST | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130456606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077533797 | ||||||||
| FaxNumber: | 6077536677 | ||||||||
| Practice Location | |||||||||
| Address1: | 4038 WEST RD | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077583008 | ||||||||
| FaxNumber: | 6077589515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2011 | ||||||||
| LastUpdateDate: | 02/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 275328 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.