Provider Demographics
NPI:1821095787
Name:OSARO, ODUAH DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ODUAH
Middle Name:DANIEL
Last Name:OSARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4425
Mailing Address - Country:US
Mailing Address - Phone:563-241-1239
Mailing Address - Fax:563-241-1243
Practice Address - Street 1:108 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4425
Practice Address - Country:US
Practice Address - Phone:563-241-1239
Practice Address - Fax:563-241-1243
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31351163WI0500X, 202C00000X, 207QA0401X, 261QU0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA9139113Medicaid
IAI13066OtherODUAH OSARO M.D;MEDICARE NUMBER
IAI12915OtherCLINTON URGENT CARE P.L.C MEDICARE NUMBER
IA31351OtherLICENSE
IAI13066OtherODUAH OSARO M.D;MEDICARE NUMBER