Healthcare Provider Details

I. General information

NPI: 1245610393
Provider Name (Legal Business Name): MARY ABIMBOLA OYEROKUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY AKINDE MD

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD FL 2
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-3488
  • Fax: 513-585-0011
Mailing address:
  • Phone: 513-263-8551
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.131879
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.131879
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: