Provider Demographics
NPI:1962969253
Name:UNEMIN, ODIANOSEN KELVIN
Entity type:Individual
Prefix:
First Name:ODIANOSEN
Middle Name:KELVIN
Last Name:UNEMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 RIDGE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3046
Mailing Address - Country:US
Mailing Address - Phone:832-677-7406
Mailing Address - Fax:
Practice Address - Street 1:210 RIDGE DR APT 2
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3046
Practice Address - Country:US
Practice Address - Phone:832-677-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty