Individual
DR. OLUWAGBENGA SERRANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1813 WILLOW ST STE 5B, VINCENNES, IN 47591-4279
(812) 882-2703
(812) 882-2760
Mailing address
1813 WILLOW ST STE 5B, VINCENNES, IN 47591-4279
(812) 882-2703
(812) 882-2760
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01049379A
IN
207RG0100X
Gastroenterology Physician
2160261
NY
207RG0100X
Gastroenterology Physician
8773
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001180285
ANTHEM
IN
05
—
201207410
—
IN
01
—
258190110
MEDICARE
IN
05
—
639396
—
AZ
Enumeration date
08/12/2005
Last updated
09/28/2018
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