Provider Demographics
NPI:1053524967
Name:ALLI, OLUSEUN OLUKAYODE (MD)
Entity type:Individual
Prefix:DR
First Name:OLUSEUN
Middle Name:OLUKAYODE
Last Name:ALLI
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-343-9800
Mailing Address - Fax:704-347-2011
Practice Address - Street 1:125 QUEENS RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3578
Practice Address - Country:US
Practice Address - Phone:704-343-9800
Practice Address - Fax:704-347-2011
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01363207RC0000X, 207RI0011X, 207RC0000X, 207RI0011X
AL31807207RC0000X
MN53258207RC0000X
MN105005207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL31807OtherALABAMA BOARD OF MEDICINE
PAMT184901OtherMED TRAINING NUMBER
MN060003382Medicare PIN