Healthcare Provider Details

I. General information

NPI: 1497557136
Provider Name (Legal Business Name): ELWIN RUTAYOMBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALBERT SABIN WAY ML 0558
CINCINNATI OH
45267-0558
US

IV. Provider business mailing address

3840 TACK ROOM RD
AUBREY TX
76227-4975
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4206
  • Fax:
Mailing address:
  • Phone:
  • 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: