Individual
EROMOSELE ANTHONY OTOADESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1753 W RIDGEWAY AVE STE 111, WATERLOO, IA 50701-4588
(219) 233-6211
(319) 233-2164
Mailing address
PO BOX 2660, WATERLOO, IA 50704-2660
(319) 233-6621
(319) 233-2164
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
28663
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2091736
—
IA
01
—
421417307C4
JOHN DEERE HEALTH INS PLA
IA
01
—
46994
WELLMARK INS PLAN
IA
Enumeration date
05/18/2006
Last updated
04/29/2020
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