Healthcare Provider Details

I. General information

NPI: 1053545269
Provider Name (Legal Business Name): EUCHARIA CHINWE AKUSOBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
SPRINGFIELD OH
45504-2687
US

IV. Provider business mailing address

3849 CARBERRY DR
DUBLIN OH
43016-7289
US

V. Phone/Fax

Practice location:
  • Phone: 330-994-4389
  • Fax: 330-451-4142
Mailing address:
  • Phone: 614-783-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.088446
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: