Doctor Name: | STEPHEN OMOBUDE |
NPI Number: | 1124156286 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | STNA 400457110205 |
Business Practice Address: | 3413 Desota Ave Cleveland Hts, OH - 44118 |
Business Phone Number: | 2167381255 |
Business Fax Number: | 2167381255 |
Mailing Address: | 3413 Desota Ave, CLEVELAND HTS |
State: | OH |
Postal Code: | 44118 |
Phone Number: | 2167381255 |
Fax Number: | 2167381255 |
NPI Enumeration Date: | 03/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 172A00000X |
License Number: | STNA 400457110205 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Driver |
Taxonomy Specialization: | |
Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |