Provider Demographics
NPI:1699755876
Name:IBOAYA, BENAHILI U (DO)
Entity type:Individual
Prefix:DR
First Name:BENAHILI
Middle Name:U
Last Name:IBOAYA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 FOX RUN RD STE C
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8401
Mailing Address - Country:US
Mailing Address - Phone:567-525-3163
Mailing Address - Fax:567-525-3169
Practice Address - Street 1:655 FOX RUN RD STE C
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-8401
Practice Address - Country:US
Practice Address - Phone:567-525-3163
Practice Address - Fax:567-525-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009331174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2956592Medicaid
OH2956592Medicaid