Healthcare Provider Details

I. General information

NPI: 1700198660
Provider Name (Legal Business Name): AMADIN ONOME OSAYOMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 JEFFERSON ST N
WADENA MN
56482-1264
US

IV. Provider business mailing address

415 JEFFERSON ST N
WADENA MN
56482-1264
US

V. Phone/Fax

Practice location:
  • Phone: 218-631-3510
  • Fax: 218-631-7503
Mailing address:
  • Phone: 218-631-3510
  • Fax: 218-631-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.133491
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.058911
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: