Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301087288 | MI |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 11958 | ND |
N | 2080P0207X | Pediatric Hematology-Oncologist | 54658 | MN |
NPI | 1053514844 |
---|---|
Provider Name | Dr. Samuel Odame Anim |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Fargo, ND 58102-3641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 04/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16941 | (05) | ND |