Healthcare Provider Details

I. General information

NPI: 1417716515
Provider Name (Legal Business Name): AJOKE M IROMINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

5250 N KNOXVILLE AVE APT 507
PEORIA IL
61614-5051
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-2563
  • Fax: 513-751-8638
Mailing address:
  • Phone: 872-235-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: