Provider Demographics
NPI:1043281686
Name:OSINBOWALE, ABRAHAM O (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:O
Last Name:OSINBOWALE
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 1:318 E UNIVERSITY AVE
Mailing Address - Street 2:PRIMARY CARE OF CINCINNATI INC
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2431
Mailing Address - Country:US
Mailing Address - Phone:513-961-1100
Mailing Address - Fax:513-961-7156
Practice Address - Street 1:318 E UNIVERSITY AVE
Practice Address - Street 2:PRIMARY CARE OF CINCINNATI INC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2431
Practice Address - Country:US
Practice Address - Phone:513-961-1100
Practice Address - Fax:513-961-7156
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350497260208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962203Medicaid
A81752Medicare UPIN
OH9266821Medicare ID - Type Unspecified