Provider Demographics
NPI:1144286634
Name:OKUNADE, MAUSI A (MD)
Entity type:Individual
Prefix:DR
First Name:MAUSI
Middle Name:A
Last Name:OKUNADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 AUBURN AVENUE
Mailing Address - Street 2:ROOM 6166
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-585-3488
Mailing Address - Fax:513-585-0011
Practice Address - Street 1:2139 AUBURN AVENUE
Practice Address - Street 2:ROOM 6166
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-3488
Practice Address - Fax:513-585-0011
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350825510207Q00000X
OH35.082551207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64082324Medicaid
OH2486546Medicaid
I13602Medicare UPIN
OHOK4140203Medicare PIN
OH2486546Medicaid