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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