Individual provider Active NPI

Anuoluwapo Omobolanle Kolawole, DO

  • Internal Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1083455349
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5151016775 Issued in MI
Practice address
300 Lafayette Ave SE Ste 3000
Grand Rapids, MI 49503-4692
Phone
(616) 685-6919
Fax
(616) 685-3033
NPI assigned
Jun 3, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5151016775 MI Primary

Addresses

Primary practice location

300 Lafayette Ave SE Ste 3000
Grand Rapids, MI 49503-4692

Mailing address

200 Jefferson Ave SE Ste 305
Grand Rapids, MI 49503-4502
Phone (616) 685-4615

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240716002296 MI Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 6204371115

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5151016775MIMDInternal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: akolawole2785165@direct.trinity-health.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1083455349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE STE 305",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-685-4615",
            "fax_number": "616-685-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LAFAYETTE AVE SE STE 3000",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034692",
            "telephone_number": "616-685-6919",
            "fax_number": "616-685-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLAWOLE",
        "first_name": "ANUOLUWAPO",
        "middle_name": "OMOBOLANLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-03",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5151016775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.