Provider Demographics
NPI:1588810568
Name:DOSUNMU, ENIOLAMI O (MD)
Entity Type:Individual
Prefix:
First Name:ENIOLAMI
Middle Name:O
Last Name:DOSUNMU
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 1:3333 BURNET AVE
Mailing Address - Street 2:OPHTHALMOLOGY, ML 4008
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4751
Mailing Address - Fax:513-636-7911
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:OPHTHALMOLOGY, ML 4008
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4751
Practice Address - Fax:513-636-7911
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121223207W00000X
NC2012-00925207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090364Medicaid
MNENROLLEDMedicaid
IN201220790Medicaid
WIENROLLEDMedicaid
MNP00992432OtherMEDICARE - RAIL ROAD
IAENROLLEDMedicaid
IAENROLLEDMedicaid