Individual
EMMANUEL OLUSEGUN ODEYEMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 MINISTRY PKWY, WESTON, WI 54476-5220
(715) 393-3000
Mailing address
3400 MINISTRY PKWY, WESTON, WI 54476-5220
(715) 393-3000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
54067
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54067
WI STATE LIC
WI
Enumeration date
04/14/2010
Last updated
04/14/2010
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