Provider Demographics
NPI:1295722858
Name:ABUNKU, ORDUEN (MD)
Entity type:Individual
Prefix:
First Name:ORDUEN
Middle Name:
Last Name:ABUNKU
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 1:8351 COUNTRY OAKS STA
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8351 COUNTRY OAKS STA
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2769
Practice Address - Country:US
Practice Address - Phone:513-759-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291931207U00000X, 208D00000X
OH35-07-5321-A207U00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22000000331910OtherBLUE CROSS AND BLUE SHIEL
OH0007854635OtherAETNA
OH023111OtherUNITEDHEALTHCARE
OH2360592Medicaid
OHAB4068331Medicare ID - Type Unspecified
OH2360592Medicaid