Provider Demographics
NPI:1053752105
Name:OLATUNDE, IGBAGBOYEMI TEMIDAYO (MD)
Entity type:Individual
Prefix:DR
First Name:IGBAGBOYEMI
Middle Name:TEMIDAYO
Last Name:OLATUNDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:1850 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2627
Practice Address - Country:US
Practice Address - Phone:803-376-5982
Practice Address - Fax:803-376-5987
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88536207R00000X
OH35.134246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine