Provider Demographics
NPI:1528465853
Name:UGBEYE, TOSAN AMUYIRIGBORTISE (AA-C)
Entity type:Individual
Prefix:
First Name:TOSAN
Middle Name:AMUYIRIGBORTISE
Last Name:UGBEYE
Suffix:
Gender:M
Credentials:AA-C
Other - Prefix:
Other - First Name:AMUYIRIGBORITSE
Other - Middle Name:TOSAN
Other - Last Name:UGBEYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CAA
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-7800
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT135.0000034367H00000X
OH67.000240367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156897Medicaid