MEDICARE: ODAM COMMUNITY CLINICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
2	207RR0500X	Rheumatology Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	208000000X	Pediatrics Physician
5	2084P0800X	Psychiatry Physician
6	207K00000X	Allergy & Immunology Physician
7	207Q00000X	Family Medicine Physician
8	207R00000X	Internal Medicine Physician
9	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1194437061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODAM COMMUNITY CLINICS

Provider Business Mailing Address
First Line	:	2015 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2813
Country	:	US
Telephone Number	:	763-285-4916
Fax Number	:	612-345-4191

Provider Business Practice Location Address
First Line	:	2015 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2813
Country	:	US
Telephone Number	:	763-285-4916
Fax Number	:	612-345-4191

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ROBERT LARBI-ODAM
Credential	:	MD, MPH
Telephone Number	:	952-228-0420

Provider Enumeration Date	:	12/21/2022
Last Update Date	:	03/31/2023

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Directions to “ODAM COMMUNITY CLINICS ” Practice Location

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