Individual
EROMONSELE O. IDAHOSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8354 LITTLE EAGLE COURT, SUITE C, INDIANAPOLIS, IN 46234
(317) 291-1211
(317) 291-1194
Mailing address
8354 LITTLE EAGLE COURT, SUITE C, INDIANAPOLIS, IN 46234
(317) 291-1211
(317) 291-1194
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01057350A
IN
207P00000X
Emergency Medicine Physician
01057350A
IN
207R00000X
Internal Medicine Physician
Primary
01057350A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200811720
—
IN
Enumeration date
09/12/2005
Last updated
10/06/2011
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