Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036134772 | IL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036134772 | IL |
NPI | 1467618561 |
---|---|
Provider Name | Dr. Didi Omiyi |
First Address | Mattoon, IL 61938-4653 |
Second Address | Effingham, IL 62401-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 27/01/2022 |