Healthcare Provider Details

I. General information

NPI: 1700700218
Provider Name (Legal Business Name): MICHAEL B OGUNJI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 ROOKERY CT
NEW ALBANY OH
43054-8157
US

IV. Provider business mailing address

5980 ROOKERY CT
NEW ALBANY OH
43054-8157
US

V. Phone/Fax

Practice location:
  • Phone: 614-779-5432
  • Fax:
Mailing address:
  • Phone: 614-779-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS.2605110-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: