Healthcare Provider Details

I. General information

NPI: 1194259127
Provider Name (Legal Business Name): SAMIAT AGUNBIADE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE
AURORA CO
80045-2527
US

IV. Provider business mailing address

12631 E 17TH AVE
AURORA CO
80045-2527
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-9251
  • Fax:
Mailing address:
  • Phone: 303-724-9251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberDR.0077635
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD483012
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0077635
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: