Individual
KUDIRAT BUKOLA OLATUNDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
333 PINE RIDGE BLVD, WAUSAU, WI 54401-4187
(800) 283-2881
Mailing address
5556 OAKWOOD AVE, STEVENS POINT, WI 54482-9164
(708) 539-3715
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
83596-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
0116035037
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007Q00000X
FAMILY MEDICINE
VA
Enumeration date
05/27/2021
Last updated
06/26/2024
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