Healthcare Provider Details

I. General information

NPI: 1457799074
Provider Name (Legal Business Name): CHIDINMA AKUSOBA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W BROAD ST
COLUMBUS OH
43228-1607
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-2058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.129073
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: