Basic Information
| Provider Information | |||||||||
| NPI: | 1336347574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALAMI | ||||||||
| FirstName: | OLUDAMILOLA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34700 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | OCONOMOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530664500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626464411 | ||||||||
| FaxNumber: | 2626461049 | ||||||||
| Practice Location | |||||||||
| Address1: | 34700 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | OCONOMOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530664500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626464411 | ||||||||
| FaxNumber: | 2626461049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 54719-020 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | D0067278 | MD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1336347574 | 05 | WI | MEDICAID |