Provider Demographics
NPI:1366882623
Name:OLOTU, OLUSESAN OLUSEUN (MD)
Entity type:Individual
Prefix:DR
First Name:OLUSESAN
Middle Name:OLUSEUN
Last Name:OLOTU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8533 ROYAL COUNTY DOWN DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1680
Mailing Address - Country:US
Mailing Address - Phone:972-306-0016
Mailing Address - Fax:972-306-0017
Practice Address - Street 1:1509 W HEBRON PKWY STE 140
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6492
Practice Address - Country:US
Practice Address - Phone:972-306-0016
Practice Address - Fax:972-306-0017
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2022-07-10
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Provider Licenses
StateLicense IDTaxonomies
TXR0088207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR0088OtherTEXAS LICENSE