Provider Demographics
NPI:1942238605
Name:ABUNYEWA, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:ABUNYEWA
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 1:13944 EUCLID AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3832
Mailing Address - Country:US
Mailing Address - Phone:216-761-9617
Mailing Address - Fax:
Practice Address - Street 1:13944 EUCLID AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3832
Practice Address - Country:US
Practice Address - Phone:216-761-9617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2421785Medicaid
H83693Medicare UPIN
OH2421785Medicaid