Provider Demographics
NPI:1821476680
Name:OSAKUE, OSATOHANWEN TEMISAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:OSATOHANWEN
Middle Name:TEMISAREN
Last Name:OSAKUE
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 1:500 GYPSY LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1315
Mailing Address - Country:US
Mailing Address - Phone:330-884-0795
Mailing Address - Fax:330-884-0651
Practice Address - Street 1:500 GYPSY LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1315
Practice Address - Country:US
Practice Address - Phone:330-884-0795
Practice Address - Fax:330-884-0651
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101267777208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty