1033173273 NPI number — WAHEED ADEWUMI M.D.

Table of content: WAHEED ADEWUMI M.D. (NPI 1033173273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033173273 NPI number — WAHEED ADEWUMI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEWUMI
Provider First Name:
WAHEED
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033173273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11497 SPRINGFIELD PIKE STE 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGDALE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45246-3551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-326-2040
Provider Business Mailing Address Fax Number:
513-771-0241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4763 SADDLETOP RIDGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45040-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-302-3664
Provider Business Practice Location Address Fax Number:
513-204-1509
Provider Enumeration Date:
04/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35-083640 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 71011685 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00277464 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2496375 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000371883 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".