Provider Demographics
NPI:1801846191
Name:SOBANDE, PATRICK OLAMIDOTUN (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:OLAMIDOTUN
Last Name:SOBANDE
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:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-5390
Practice Address - Street 1:1 CHILDRENS PLZ
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1815
Practice Address - Country:US
Practice Address - Phone:937-641-3376
Practice Address - Fax:937-641-4500
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHBS085674208000000X
WI65599-202080P0214X
OH35.0856742080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
310833936OtherHUMANA
IN100012670Medicaid
OH0307822Medicaid
KY65901886Medicaid
OH0307822Medicaid
I49202Medicare UPIN
SO7340411Medicare ID - Type Unspecified