Oluwaseun Ogunsuyi Oguntomole

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4351054019 Issued in MI

Practice address

205 N East Ave
Jackson, MI 49201-1753

Phone

(517) 205-3998

Fax

(517) 205-7050

NPI assigned

Apr 2, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: ooguntomole1078829@direct.hfhs.org

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

{
    "created_epoch": "1743552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1356145072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 WELLS BRANCH PKWY APT 1335",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787287173",
            "telephone_number": "504-875-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-3998",
            "fax_number": "517-205-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OGUNTOMOLE",
        "first_name": "OLUWASEUN",
        "middle_name": "OGUNSUYI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-02",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4351054019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Wells Oconnell, LMSW
• Odd Fellow & Rebekah Home of Michigan
• Office 4 PLLC
• Delis Ogando, DDS
• Francis Ogunedo
• Paulina Ohrey
• Colin T Okeefe, BSW
• Wilhelm Franz Okken, CRNA
• Danielle Lynn Okley, MA CCC SLP
• Cami Oliver, RN

• Family Medicine Physician in Jackson, MI
• Providers in Jackson, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.