Organization
ODAM MEDICAL GROUP
Active
Organization
ODAM MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LARBI-ODAM M.D. (CEO/MEDICAL DIRECTOR)
(952) 992-9305
Entity
Organization
Contact information
Practice address
6014 LAKELAND AVE N, CRYSTAL, MN 55428-2984
(612) 871-2312
(612) 871-2163
Mailing address
6014 LAKELAND AVE N, CRYSTAL, MN 55428-2984
(612) 871-2312
(612) 871-2163
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
10/14/2015
Last updated
12/22/2022
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