| Odam Medical Group | |
|
6014 Lakeland Ave N Crystal MN 55428-2984 | |
| (612) 871-2312 | |
| (612) 871-2163 |
| Full Name | Odam Medical Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 6014 Lakeland Ave N, Crystal, Minnesota |
| Authorized Official Name and Position | Robert Larbi-odam (CEO/MEDICAL DIRECTOR) |
| Authorized Official Contact | 9529929305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Odam Medical Group 6014 Lakeland Ave N Crystal MN 55428-2984 Ph: (612) 871-2312 | Odam Medical Group 6014 Lakeland Ave N Crystal MN 55428-2984 Ph: (612) 871-2312 |
| NPI Number | 1578934683 |
|---|---|
| Provider Enumeration Date | 10/14/2015 |
| Last Update Date | 12/22/2022 |
| Medicare PECOS PAC ID | 4082911938 |
|---|---|
| Medicare Enrollment ID | O20160321002318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578934683 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Robert Larbi-odam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457311409 PECOS PAC ID: 3678528809 Enrollment ID: I20050321000488 |
| Provider Name | Samuel Y Boadu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063517100 PECOS PAC ID: 0941207609 Enrollment ID: I20061023000424 |
| Provider Name | Selase Agudu-morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891278693 PECOS PAC ID: 1951646397 Enrollment ID: I20181213000754 |
| Provider Name | Muna Saeed Farah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780247015 PECOS PAC ID: 5890144851 Enrollment ID: I20231215001740 |
| Provider Name | Julitta Adu-gyamfi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356119523 PECOS PAC ID: 5799121125 Enrollment ID: I20240307004039 |
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