Basic Information
| Provider Information | |||||||||
| NPI: | 1841269834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABE | ||||||||
| FirstName: | OLUWOLE | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407430936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063307840 | ||||||||
| FaxNumber: | 6063307825 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 W 5TH ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407412112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068644040 | ||||||||
| FaxNumber: | 6068643500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 07/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 36997 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 36997 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 10801904 | 01 | CAQH | OTHER | C04236 | 01 | KY | CHI-PRIMARY CARE NUMBER | OTHER | 010016193 | 05 | VA | MEDICAID | C211117 | 01 | KY | CHI | OTHER | 50005786 | 01 | KY | PASPORT HEALTH PLAN | OTHER | P11201719 | 01 | MULTIPLAN | OTHER | 859456 | 01 | USA MANAGED CARE | OTHER | 1196138 | 01 | KY | CHA | OTHER | 64047483 | 05 | KY | MEDICAID | 000000227463 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER | 000000584952 | 01 | KY | BCBS-CUMBERLAND CLINIC | OTHER |