Individual
SAMUEL AGUBOSIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1574 HENTHORNE DR, SUITE C, MAUMEE, OH 43537-1397
(419) 794-1170
(419) 794-1171
Mailing address
1574 HENTHORNE DR, SUITE C, MAUMEE, OH 43537-1397
(419) 794-1170
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35074877
OH
207LP2900X
Pain Medicine (Anesthesiology) Physician
35074877
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000220323
ANTHEM
OH
05
—
2132187
—
OH
05
—
2873887
—
OH
01
—
P00694361
MEDICARE RAILROAD
OH
Enumeration date
09/02/2005
Last updated
05/02/2017
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