Healthcare Provider Details

I. General information

NPI: 1649252958
Provider Name (Legal Business Name): AUGUSTUS K. EDUAFO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TURNER RD
DAYTON OH
45415-3630
US

IV. Provider business mailing address

500 LINCOLN PARK BLVD. SUITE 100
KETTERING OH
45429-6410
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-5162
  • Fax: 937-522-0485
Mailing address:
  • Phone: 937-222-3118
  • Fax: 937-222-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35.72679
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: