MEDICARE: AUGUSTUS K. EDUAFO 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	207RN0300X	Nephrology Physician	35.72679	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3108215037020	OTHER	UNITED MINE WORKERS
2	928194	OTHER	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	D72679	OTHER	HUMANA
5	390005566	OTHER	RAILROAD
6	000000008696	OTHER	ANTHEM
7	0828263	OTHER	PTAN
8	310821503035	OTHER	CARE SOURCE
9	390005566	OTHER	UHC

General Provider Information

NPI Number	:	1649252958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUGUSTUS K. EDUAFO M.D.

Provider Business Mailing Address
First Line	:	500 LINCOLN PARK BLVD.
Second Line	:	SUITE 100
City	:	KETTERING
State	:	OH
Zip	:	45429-6410
Country	:	US
Telephone Number	:	937-222-3118
Fax Number	:	937-222-1436

Provider Business Practice Location Address
First Line	:	455 TURNER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3630
Country	:	US
Telephone Number	:	937-496-5162
Fax Number	:	937-522-0485

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	10/22/2025

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