MEDICARE: ODUAH DANIEL OSARO M.D

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WI0500X	Infusion Therapy Registered Nurse	31351	IA
2	202C00000X	Independent Medical Examiner Physician	31351	IA
3	207QA0401X	Addiction Medicine (Family Medicine) Physician	31351	IA
4	261QU0200X	Urgent Care Clinic/Center	31351	IA
5	207Q00000X	Family Medicine Physician	31351	IA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	I13066	OTHER	IA	ODUAH OSARO M.D;MEDICARE NUMBER
3	I12915	OTHER	IA	CLINTON URGENT CARE P.L.C MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	31351	OTHER	IA	LICENSE

General Provider Information

NPI Number	:	1821095787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODUAH DANIEL OSARO M.D

Provider Business Mailing Address
First Line	:	108 S 4TH ST
Second Line	:
City	:	CLINTON
State	:	IA
Zip	:	52732-4425
Country	:	US
Telephone Number	:	563-241-1239
Fax Number	:	563-241-1243

Provider Business Practice Location Address
First Line	:	108 S 4TH ST
Second Line	:
City	:	CLINTON
State	:	IA
Zip	:	52732-4425
Country	:	US
Telephone Number	:	563-241-1239
Fax Number	:	563-241-1243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	02/10/2020

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