Provider Demographics
NPI:1538504139
Name:ESAN, MICHAEL OLUSEGUN (MD, PH D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:OLUSEGUN
Last Name:ESAN
Suffix:
Gender:M
Credentials:MD, PH D
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Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, M-136 RIVERSIDE EAST BUILDING
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-624-4477
Mailing Address - Fax:612-626-7042
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS, M-136 RIVERSIDE EAST BUILDING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-624-4477
Practice Address - Fax:612-626-7042
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MN602042080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program