Provider Demographics
NPI:1093195489
Name:AJAYI, OLUFUNKE O (MBBS)
Entity Type:Individual
Prefix:DR
First Name:OLUFUNKE
Middle Name:O
Last Name:AJAYI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:OLUFUNKE
Other - Middle Name:
Other - Last Name:IKUOPENIKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:CENTRACARE CLINIC ST CLOUD MEDICAL GROUP SOUTH
Mailing Address - Street 2:1301 33RD ST S
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9668
Mailing Address - Country:US
Mailing Address - Phone:320-251-8181
Mailing Address - Fax:320-257-1733
Practice Address - Street 1:CENTRACARE CLINIC ST CLOUD MEDICAL GROUP SOUTH
Practice Address - Street 2:1301 33RD ST S
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-9668
Practice Address - Country:US
Practice Address - Phone:320-251-8181
Practice Address - Fax:320-257-1733
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN63031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program