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Individual

OLUREMI C ADESIDA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
11115 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 373-9965
(260) 458-5664
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01068108A
IN
208000000X
Pediatrics Physician
036-116960
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
01068108A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
036-116960
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000655415
ANTHEM
IN
05
001289011
PA
05
200979870
IN
05
8466700
NJ
Enumeration date
07/13/2006
Last updated
04/21/2021
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