Provider Demographics
NPI:1033173273
Name:ADEWUMI, WAHEED (MD)
Entity Type:Individual
Prefix:
First Name:WAHEED
Middle Name:
Last Name:ADEWUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11497 SPRINGFIELD PIKE STE 5
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3551
Mailing Address - Country:US
Mailing Address - Phone:513-326-2040
Mailing Address - Fax:513-771-0241
Practice Address - Street 1:4763 SADDLETOP RIDGE LN
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-3852
Practice Address - Country:US
Practice Address - Phone:419-302-3664
Practice Address - Fax:513-204-1509
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH71011685OtherAETNA
OHP00277464OtherMEDICARE RAILROAD
OH2496375Medicaid
OH000000371883OtherANTHEM
OH71011685OtherAETNA
OHAD4133574Medicare ID - Type Unspecified
OHG61460Medicare UPIN