Active NPI
Patrick Olubunmi Omotoso, M.D
- Vascular Surgery Physician
- Cleveland, OH
National Provider Identifier
1306175336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 57.017315
- Practice address
- 9500 Euclid Ave
F30
Cleveland, OH 44195-0001 - Phone
- (216) 444-4766
- NPI assigned
- Dec 22, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | 57.017315 | OH | Primary |
Addresses
Primary practice location
9500 Euclid Ave
F30
Cleveland, OH 44195-0001
Mailing address
30 Severance Cir
Apt 008
Cleveland Heights, OH 44118-1531
Phone (216) 647-1991
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57.017315 | OH | MD | Vascular Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261440000000",
"number": "1306175336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 SEVERANCE CIR",
"address_2": "APT 008",
"city": "CLEVELAND HEIGHTS",
"state": "OH",
"postal_code": "441181531",
"telephone_number": "216-647-1991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9500 EUCLID AVE",
"address_2": "F30",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441950001",
"telephone_number": "216-444-4766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMOTOSO",
"first_name": "PATRICK",
"middle_name": "OLUBUNMI",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-12-22",
"last_updated": "2009-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "OH",
"license": "57.017315",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.