| Doctor Name: | TEMITOPE OLADOKUN OLAGBAIYE |
| NPI Number: | 1043561277 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | 4704252765 |
| Business Practice Address: | 43565 Elizabeth St Mount Clemens, MI - 480431001 |
| Business Phone Number: | 5863079528 |
| Business Fax Number: | 5864696551 |
| Mailing Address: | 21646 Phoenix Dr, Apt/suite MACOMB |
| State: | MI |
| Postal Code: | 480446408 |
| Phone Number: | 5868437255 |
| Fax Number: | 5868437255 |
| NPI Enumeration Date: | 09/27/2012 |
| NPI Last Update Date: | 10/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704252765 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |