MEDICARE: DR. DONALD EGHOBAMIEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35079013E	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497740260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD EGHOBAMIEN M.D.

Provider Business Mailing Address
First Line	:	5831 ALBERTA DR
Second Line	:
City	:	LYNDHURST
State	:	OH
Zip	:	44124-3910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2322 E 22ND ST
Second Line	:	360
City	:	CLEVELAND
State	:	OH
Zip	:	44115-3176
Country	:	US
Telephone Number	:	216-363-7421
Fax Number	:	216-363-2768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	11/29/2011

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