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Organization
ANDERSON AND ODUNSI, MD LLC
Active
Organization
ANDERSON AND ODUNSI, MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA K. ANDERSON M.D. (MEDICAL DOCTOR OB-GYN)
(217) 876-8370
Entity
Organization
Contact information
Practice address
2 MEMORIAL DR, SUITE 305, DECATUR, IL 62526-3950
(217) 876-8370
(217) 876-8375
Mailing address
2 MEMORIAL DR, SUITE 305, DECATUR, IL 62526-3950
(217) 876-8370
(217) 876-8375
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
036069886
IL
207V00000X
Obstetrics & Gynecology Physician
Primary
036094384
IL
363L00000X
Nurse Practitioner
209001529
IL
363LW0102X
Women's Health Nurse Practitioner
209000428
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05832021
BLUE CROSS BLUE SHIELD GR
IL
01
—
DA0763
MEDICARE RAILROAD
IL
Enumeration date
01/09/2007
Last updated
08/07/2012
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