Provider Demographics
NPI:1629241468
Name:KAFARU, MUKAILA ABIODUN
Entity Type:Individual
Prefix:MR
First Name:MUKAILA
Middle Name:ABIODUN
Last Name:KAFARU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 LEE BLVD
Mailing Address - Street 2:SUITE# 319 B
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1268
Mailing Address - Country:US
Mailing Address - Phone:216-371-7065
Mailing Address - Fax:216-371-7060
Practice Address - Street 1:2490 LEE BLVD
Practice Address - Street 2:SUITE# 319 B
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-3204
Practice Address - Country:US
Practice Address - Phone:216-371-7065
Practice Address - Fax:216-371-7060
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187295343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2800124Medicaid