Individual
OLUDARE ONISILE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4607 N 12TH ST, PHOENIX, AZ 85014-4006
(602) 222-8727
Mailing address
4607 N 12TH ST, PHOENIX, AZ 85014-4006
(602) 222-8727
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23710
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
329286
—
AZ
Enumeration date
06/04/2006
Last updated
07/08/2007
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