Provider Demographics
NPI:1538059779
Name:ODAM MEDICAL GROUP
Entity type:Organization
Organization Name:ODAM MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LARBI-ODAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-871-2312
Mailing Address - Street 1:700 PENN ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-8700
Mailing Address - Country:US
Mailing Address - Phone:320-774-3800
Mailing Address - Fax:612-871-2163
Practice Address - Street 1:700 PENN ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8700
Practice Address - Country:US
Practice Address - Phone:320-774-3800
Practice Address - Fax:320-774-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health