Healthcare Provider Details

I. General information

NPI: 1730136615
Provider Name (Legal Business Name): AYODELE L ADEBAYO MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 CENTER HILL AVE FE-A4
CINCINNATI OH
45224-1705
US

IV. Provider business mailing address

6105 CENTER HILL AVE FE-A4
CINCINNATI OH
45224-1705
US

V. Phone/Fax

Practice location:
  • Phone: 513-634-1622
  • Fax: 513-386-1807
Mailing address:
  • Phone: 513-634-1622
  • Fax: 513-386-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35084960
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35.084960
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: