Provider Demographics
NPI:1750341293
Name:BAMIRO, OLUJIDE (MD)
Entity type:Individual
Prefix:
First Name:OLUJIDE
Middle Name:
Last Name:BAMIRO
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 708790
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8790
Mailing Address - Country:US
Mailing Address - Phone:800-846-5313
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:1761 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2342
Practice Address - Country:US
Practice Address - Phone:330-263-8326
Practice Address - Fax:330-263-8243
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087398207R00000X
GA059369207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00382832OtherRR MEDICARE
OH2674584Medicaid
OH000000495991OtherBC/BS OF OHIO
OH000000495991OtherBC/BS OF OHIO
OHP00382832OtherRR MEDICARE
GA511I110785Medicare PIN