Provider Demographics
NPI:1497860597
Name:FESTUS-ABIBO, LAETITIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAETITIA
Middle Name:
Last Name:FESTUS-ABIBO
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 1:8884 MOTTER LN
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5469
Mailing Address - Country:US
Mailing Address - Phone:937-312-1946
Mailing Address - Fax:
Practice Address - Street 1:4100 W THIRD ST
Practice Address - Street 2:VAMC,
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine