Healthcare Provider Details

I. General information

NPI: 1831117522
Provider Name (Legal Business Name): AYOOLA K GOMIH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 W 80TH PL
MERRILLVILLE IN
46410-5432
US

IV. Provider business mailing address

398 W 80TH PL
MERRILLVILLE IN
46410-5432
US

V. Phone/Fax

Practice location:
  • Phone: 219-791-0615
  • Fax: 219-791-0619
Mailing address:
  • Phone: 219-791-0615
  • Fax: 219-791-0619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01032453B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01032453B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: