Provider Demographics
NPI:1861788432
Name:SHOFU, ABIMBOLA A (MD)
Entity type:Individual
Prefix:DR
First Name:ABIMBOLA
Middle Name:A
Last Name:SHOFU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ABIMBOLA
Other - Middle Name:A
Other - Last Name:OGUNGBEMILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 REFUGEE RD STE 310
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9653
Practice Address - Country:US
Practice Address - Phone:614-788-4390
Practice Address - Fax:614-788-4399
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134152207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease