=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649252958
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUGUSTUS K. EDUAFO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2005
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 TURNER RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45415-3630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-496-5162
-----------------------------------------------------
Fax | 937-522-0485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 LINCOLN PARK BLVD. SUITE 100
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-6410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-222-3118
-----------------------------------------------------
Fax | 937-222-1436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 35.72679
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------