Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 01049148A | IN |
NPI | 1013951235 |
---|---|
Provider Name | Olajide O Odelowo |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 09/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200367920A | (05) | IN |
H55836 | (02) |