Healthcare Provider Details

I. General information

NPI: 1205049012
Provider Name (Legal Business Name): JOHN N KAMAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S SHOOP AVE
WAUSEON OH
43567-1702
US

IV. Provider business mailing address

26787 LAKEVUE DR
PERRYSBURG OH
43551-3360
US

V. Phone/Fax

Practice location:
  • Phone: 419-330-2605
  • Fax: 419-330-2649
Mailing address:
  • Phone: 419-873-0351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301091905
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.089074
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: