Organization
COLADOM MEDICAL GROUP, P.A.
Active
Organization
COLADOM MEDICAL GROUP, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOLAWOLE ADEMUYIWA ODULAJA M.D. (DIRECTOR)
(210) 455-0074
Entity
Organization
Contact information
Practice address
510 MED CT, SUITE 107, SAN ANTONIO, TX 78258-3482
(210) 455-0074
(210) 455-0124
Mailing address
510 MED CT, SUITE 107, SAN ANTONIO, TX 78258-3482
(210) 455-0074
(210) 455-0124
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
N2694
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008TN
BLUE CROSS BLUE SHIELD OF TEXAS
—
05
—
217153001
—
TX
Enumeration date
05/19/2010
Last updated
08/19/2011
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