Provider Demographics
NPI:1215976451
Name:ODI, EMMANUEL O (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:O
Last Name:ODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BROOKWOOD BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6862
Mailing Address - Country:US
Mailing Address - Phone:205-802-6773
Mailing Address - Fax:205-871-9647
Practice Address - Street 1:513 BROOKWOOD BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6862
Practice Address - Country:US
Practice Address - Phone:205-802-6773
Practice Address - Fax:205-871-9647
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00024167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009937655Medicaid
AL51518288OtherBCBS OF ALABAMA
ALP00086293OtherRAILROAD MEDICARE
ALH45387Medicare UPIN
ALP00086293OtherRAILROAD MEDICARE