Provider Demographics
NPI:1366064560
Name:OLUWADAMISI, CALEB IFEOLUWA (MD)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:IFEOLUWA
Last Name:OLUWADAMISI
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 1:308 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-1142
Mailing Address - Country:US
Mailing Address - Phone:641-394-2151
Mailing Address - Fax:
Practice Address - Street 1:308 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-1142
Practice Address - Country:US
Practice Address - Phone:641-394-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IAMD-51074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program