Provider Demographics
NPI:1699762260
Name:TRISTATE HOME PHYSICIANS
Entity type:Organization
Organization Name:TRISTATE HOME PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ORDUEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUNKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-759-9018
Mailing Address - Street 1:8351 COUNTRY OAKS STA
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2769
Mailing Address - Country:US
Mailing Address - Phone:513-759-9018
Mailing Address - Fax:
Practice Address - Street 1:8351 COUNTRY OAKS STA
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2769
Practice Address - Country:US
Practice Address - Phone:513-759-9018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-5321A207U00000X
KY34820207U00000X, 208D00000X
OH35-07-5321-A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH023111OtherCONTRACT
OH22000000331910OtherPROVIDER NUMBER
OH9338601Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER