Provider Demographics
NPI:1366546525
Name:ILUYOMADE, OLAKUNLE (MD)
Entity type:Individual
Prefix:
First Name:OLAKUNLE
Middle Name:
Last Name:ILUYOMADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 ELM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3764
Mailing Address - Country:US
Mailing Address - Phone:214-222-3571
Mailing Address - Fax:214-744-5131
Practice Address - Street 1:475 ELM ST STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3764
Practice Address - Country:US
Practice Address - Phone:214-222-3571
Practice Address - Fax:214-744-5131
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7288207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00788798OtherRR MEDICARE
TX1882896-03Medicaid
TX1882896-03Medicaid
TX8J7645Medicare PIN
TX8F8414Medicare PIN
TXP00788798OtherRR MEDICARE
TX8F9579Medicare PIN