Provider Demographics
NPI:1205040136
Name:MEDEYINLO, OLUSEUN O (MD)
Entity type:Individual
Prefix:DR
First Name:OLUSEUN
Middle Name:O
Last Name:MEDEYINLO
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-7700
Mailing Address - Fax:859-212-7710
Practice Address - Street 1:4900 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4824
Practice Address - Country:US
Practice Address - Phone:859-212-7700
Practice Address - Fax:859-212-7710
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41560207RC0200X, 207RP1001X
NY238066207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00633297OtherRAILROAD MEDICARE
KY7100062500Medicaid
OH2966849Medicaid
KYP00840872OtherRAILROAD MEDICARE
KYP00840872OtherRAILROAD MEDICARE
KY0974311Medicare PIN
OH2966849Medicaid
KY0387553Medicare PIN