MEDICARE: STEPHEN OMOBUDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number
1	172A00000X	Driver	STNA 400457110205
2	376J00000X	Homemaker	STNA 400457110205
3	376K00000X	Nurse's Aide	STNA 400457110205

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1807192	OTHER	OH	ODMRDD CONTRACT #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124156286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN OMOBUDE

Provider Business Mailing Address
First Line	:	3413 DESOTA AVE
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118
Country	:	US
Telephone Number	:	216-738-1255
Fax Number	:	216-738-1255

Provider Business Practice Location Address
First Line	:	3413 DESOTA AVE
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118
Country	:	US
Telephone Number	:	216-738-1255
Fax Number	:	216-738-1255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	09/11/2025

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Directions to “ STEPHEN OMOBUDE ” Practice Location

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