Provider Demographics
NPI:1841269834
Name:ABE, OLUWOLE JOHN (MD)
Entity type:Individual
Prefix:
First Name:OLUWOLE
Middle Name:JOHN
Last Name:ABE
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 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7840
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1210 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2112
Practice Address - Country:US
Practice Address - Phone:606-864-4040
Practice Address - Fax:606-864-3500
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36997207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
10801904OtherCAQH
KYC04236OtherCHI-PRIMARY CARE NUMBER
VA010016193Medicaid
KYC211117OtherCHI
KY50005786OtherPASPORT HEALTH PLAN
P11201719OtherMULTIPLAN
859456OtherUSA MANAGED CARE
KY1196138OtherCHA
KY64047483Medicaid
KY000000227463OtherBLUE CROSS BLUE SHIELD
KY000000584952OtherBCBS-CUMBERLAND CLINIC
KYC04236OtherCHI-PRIMARY CARE NUMBER
0930810Medicare ID - Type Unspecified
0305821Medicare ID - Type Unspecified
VA010016193Medicaid
KY64047483Medicaid
KYC211117OtherCHI
859456OtherUSA MANAGED CARE
110235375Medicare ID - Type UnspecifiedRAILROAD MEDICARE
0938503Medicare ID - Type Unspecified