Provider Demographics
NPI:1487037131
Name:AGIDI, SENYO (DO)
Entity Type:Individual
Prefix:
First Name:SENYO
Middle Name:
Last Name:AGIDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:PERFECT
Other - Middle Name:SENYO
Other - Last Name:AGIDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:75 ARCH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1432
Mailing Address - Country:US
Mailing Address - Phone:330-253-5088
Mailing Address - Fax:330-253-5095
Practice Address - Street 1:75 ARCH ST STE 302
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1432
Practice Address - Country:US
Practice Address - Phone:330-253-5088
Practice Address - Fax:330-253-5095
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH58007216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487037131OtherNPI
OH58007216Medicaid