Healthcare Provider Details

I. General information

NPI: 1144286634
Provider Name (Legal Business Name): MAUSI A OKUNADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVENUE ROOM 6166
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2139 AUBURN AVENUE ROOM 6166
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-3488
  • Fax: 513-585-0011
Mailing address:
  • Phone: 513-585-3488
  • Fax: 513-585-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number350825510
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35.082551
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: