National Provider Identifier Database

ODAM MEDICAL GROUP
Primary Care


Contact Information

ODAM MEDICAL GROUP
1521 NORTHWAY DR STE 116
SAINT CLOUD, MN56303-1274
Phone: 320-774-3800
Fax: 320-774-3360
Website:
Specialty Taxonomy Code
* Primary Care 261QP2300X
Rural Health 261QR1300X

* Indicates primary specialty

NPI Profile & details for ODAM MEDICAL GROUP

NPI Number 1902392525
Legal business name
LBN
ODAM MEDICAL GROUP
Authorized official ROBERT LARBI-ODAM - (CEO)
Entity Organization
Organization subpart No
Enumeration date 07/06/2018
Last updated 03/11/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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