Healthcare Provider Details

I. General information

NPI: 1801846191
Provider Name (Legal Business Name): PATRICK OLAMIDOTUN SOBANDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1815
US

IV. Provider business mailing address

PO BOX 933432
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3376
  • Fax: 937-641-4500
Mailing address:
  • Phone: 937-641-5072
  • Fax: 937-641-5390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBS085674
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number65599-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35.085674
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: