Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 27594 | WV |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 27594 | WV |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD-48319 | IA |
NPI | 1205148350 |
---|---|
Provider Name | Paul Imoudu Okhumale |
First Address | Waterloo, IA 50704-2758 |
Second Address | Waterloo, IA 50703-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 14/02/2022 |