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General NPI Number Information
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NPI Number | 1427210699
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Entity Type | Individual
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Provider Name | OLUMIDE ANUOLUWA OMIWADE MBCHB
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Gender | Male
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 2251 N SHORE DR STE 100
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City | RHINELANDER
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State | WI
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Zip | 54501-6710
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Country | US
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Telephone | 713-550-7718
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Fax |
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Provider Business Mailing Address
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Address Line | 2251 N SHORE DR STE 100
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City | RHINELANDER
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State | WI
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Zip | 54501-6710
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Country | US
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Telephone | 713-550-7718
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 55799620
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License Number State | WI
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