Individual
BENJAMIN OLU ALAN OBASEKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 747-3241
(765) 281-6567
Mailing address
3311 BROADWAY ST, INDIANAPOLIS, IN 46205-3825
(929) 375-1242
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01085608A
IN
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
01085698A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001542700
ANTHEM PTAN
IN
01
—
264430C74
MEDICARE PTAN
IN
05
—
300049390
—
IN
01
—
Q00263392
RAILROAD PTAN
IN
Enumeration date
06/04/2018
Last updated
09/14/2024
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