Provider Demographics
NPI:1184649956
Name:OBETO, KEHINDE (MD)
Entity Type:Individual
Prefix:
First Name:KEHINDE
Middle Name:
Last Name:OBETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KEHINDE
Other - Middle Name:
Other - Last Name:ERIBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2213 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1402
Mailing Address - Country:US
Mailing Address - Phone:419-251-2415
Mailing Address - Fax:
Practice Address - Street 1:2702 NAVARRE AVE STE 315
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3224
Practice Address - Country:US
Practice Address - Phone:419-696-6336
Practice Address - Fax:734-712-3855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108769208000000X
CO46228208000000X
MI4301095940208000000X
OH35-125903208M00000X
OH35125903208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135025Medicaid
CO46228OtherMEDICAL LICENSE
CO46228OtherMEDICAL LICENSE