Individual
DR. OLAYEMI O CHAMPION-ODUSOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7905 CALUMET AVE, MUNSTER, IN 46321-2549
(219) 836-5800
(219) 836-5030
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01067004A
IN
207Q00000X
Family Medicine Physician
125051108
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200951320
—
IN
Enumeration date
08/11/2008
Last updated
04/14/2023
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