Provider Demographics
NPI:1194939694
Name:WION, EBUNOLUWA B (DO)
Entity type:Individual
Prefix:
First Name:EBUNOLUWA
Middle Name:B
Last Name:WION
Suffix:
Gender:F
Credentials:DO
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 745
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-0745
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2014 BALTIMORE REYNOLDSBURG RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3261
Practice Address - Country:US
Practice Address - Phone:614-533-6440
Practice Address - Fax:614-533-0140
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4259542OtherMEDICARE PTAN
OH2906627Medicaid
OH4259541OtherMEDICARE