Provider Demographics
NPI:1225069461
Name:ODOO WANI, FREDRICK OOLA (MD)
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:OOLA
Last Name:ODOO WANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FREDRICK
Other - Middle Name:OOLA
Other - Last Name:ODOO WANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3207 MAPLEWOOD BLVD
Mailing Address - Street 2:APT #3
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5442
Mailing Address - Country:US
Mailing Address - Phone:402-968-9937
Mailing Address - Fax:
Practice Address - Street 1:MAPLEWOOD BLVD
Practice Address - Street 2:APT #3
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134
Practice Address - Country:US
Practice Address - Phone:402-968-9937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine