Healthcare Provider Details

I. General information

NPI: 1467983833
Provider Name (Legal Business Name): FELIX JOLLY ODATHIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FELIX JOLLY M.D.

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 OKEECHOBEE BLVD
WEST PALM BEACH FL
33401-6349
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 561-804-0200
  • Fax:
Mailing address:
  • Phone: 920-454-4229
  • Fax: 920-993-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME177013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73944
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: