Provider Demographics
NPI:1699044396
Name:HUNDOGAN, OLUFEMI
Entity type:Individual
Prefix:MR
First Name:OLUFEMI
Middle Name:
Last Name:HUNDOGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 HARPERS GROVE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-2860
Mailing Address - Country:US
Mailing Address - Phone:614-843-8161
Mailing Address - Fax:
Practice Address - Street 1:1311 HARPERS GROVE CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2860
Practice Address - Country:US
Practice Address - Phone:614-843-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2530710347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2651885Medicaid