Provider Demographics
NPI:1215322664
Name:SAMUEL, GBEMINIYI OLANREWAJU (MD)
Entity type:Individual
Prefix:DR
First Name:GBEMINIYI
Middle Name:OLANREWAJU
Last Name:SAMUEL
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 1:3130 N COUNTY ROAD 25A STE 109
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-440-9292
Mailing Address - Fax:937-440-4227
Practice Address - Street 1:3130 N COUNTY ROAD 25A STE 109
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1337
Practice Address - Country:US
Practice Address - Phone:937-440-9292
Practice Address - Fax:937-440-4227
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.141494207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology