Healthcare Provider Details

I. General information

NPI: 1487346318
Provider Name (Legal Business Name): BRIAN PAUL-ODIONHIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2141 S ROBINSON AVE APT 516
MILWAUKEE WI
53207-1376
US

V. Phone/Fax

Practice location:
  • Phone: 956-342-9499
  • Fax:
Mailing address:
  • Phone: 929-302-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10086154
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number87956-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number87956-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberW2553
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: