Individual
OLUKEMI AJIBOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10600 N PORT WASHINGTON RD STE 200, MEQUON, WI 53092-5084
(262) 240-3100
Mailing address
N53W15851 CREEKWOOD XING, MENOMONEE FALLS, WI 53051-0610
(262) 844-7757
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7202-023
WI
363AM0700X
Medical Physician Assistant
52375
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100227402
—
WI
Enumeration date
04/17/2015
Last updated
06/23/2023
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