Provider Demographics
NPI:1649252958
Name:EDUAFO, AUGUSTUS K (MD)
Entity type:Individual
Prefix:
First Name:AUGUSTUS
Middle Name:K
Last Name:EDUAFO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 LINCOLN PARK BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6410
Mailing Address - Country:US
Mailing Address - Phone:937-222-3118
Mailing Address - Fax:937-222-1436
Practice Address - Street 1:455 TURNER RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3630
Practice Address - Country:US
Practice Address - Phone:937-496-5162
Practice Address - Fax:937-522-0485
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH72679207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3108215037020OtherUNITED MINE WORKERS
928194OtherAETNA
OH2017089Medicaid
D72679OtherHUMANA
390005566OtherRAILROAD
000000008696OtherANTHEM
0828263OtherPTAN
310821503035OtherCARE SOURCE
390005566OtherUHC
310821503035OtherCARE SOURCE