MEDICARE: ENESI OLEFUMI MOMOH MD

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	207X00000X	Orthopaedic Surgery Physician	4301085942	MI
2	207X00000X	Orthopaedic Surgery Physician	35132377	OH

General Provider Information

NPI Number	:	1669681797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENESI OLEFUMI MOMOH MD

Provider Business Mailing Address
First Line	:	2200 JEFFERSON AVE FL 5
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43604-7102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 NAVARRE AVE STE 102
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3224
Country	:	US
Telephone Number	:	419-696-7000
Fax Number	:	419-696-7015

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	01/12/2018

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