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1124505615
MICHAEL G OMOTOLA
GRAND PRAIRIE, TX
NPI
1124505615
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
Enumeration Date
2018-07-26
Last Update Date
2018-07-26
Business Address
MICHAEL G OMOTOLA PA-C
2520 W I 20
GRAND PRAIRIE, TX 75052-7280
Phone number: 512-363-3257
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Mailing Address
MICHAEL G OMOTOLA PA-C
417 W 20TH ST UNIT 11386
NORFOLK, VA 23517-1287
Phone number: 512-363-3257
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