Provider Demographics
NPI:1598385510
Name:FATUYI, MICHAEL ADURAGBEMI (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADURAGBEMI
Last Name:FATUYI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13715 PINE NEEDLE COURT
Mailing Address - Street 2:
Mailing Address - City:UPPER-MARLBURU
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:240-593-6666
Mailing Address - Fax:
Practice Address - Street 1:375 DIXMYTH AVE., GOOD-SAMARITAN HOSPITAL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220
Practice Address - Country:US
Practice Address - Phone:240-593-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program