Individual
OMOLOLU DANIEL OMOWANILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 22ND AVE, MONROE, WI 53566-1569
(608) 324-2000
Mailing address
515 22ND AVE, MONROE, WI 53566-1569
(608) 324-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
69638-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2015
Last updated
12/23/2020
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