Provider Demographics
NPI:1437402716
Name:LABITUE, FANTA POWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:FANTA
Middle Name:POWELL
Last Name:LABITUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 RYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-5126
Mailing Address - Country:US
Mailing Address - Phone:301-213-6397
Mailing Address - Fax:
Practice Address - Street 1:1118 RYLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-5126
Practice Address - Country:US
Practice Address - Phone:301-213-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057554416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine