Provider Demographics
NPI:1154303394
Name:OSOTEO, RAFAEL P JR (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:P
Last Name:OSOTEO
Suffix:JR
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 1:361 E WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319
Mailing Address - Country:US
Mailing Address - Phone:330-773-7866
Mailing Address - Fax:330-773-5090
Practice Address - Street 1:361 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319
Practice Address - Country:US
Practice Address - Phone:330-773-7866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0224635Medicaid
OHC01070Medicare UPIN
OH0393244Medicare PIN