Provider Demographics
NPI:1538659198
Name:ABOKEDE-RAHAMAN, OLABISI F (TRAINING CERT MD)
Entity Type:Individual
Prefix:
First Name:OLABISI
Middle Name:F
Last Name:ABOKEDE-RAHAMAN
Suffix:
Gender:F
Credentials:TRAINING CERT MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72030
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:419-479-5893
Mailing Address - Fax:419-479-5878
Practice Address - Street 1:10961 CLUB WEST PKWY
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5866
Practice Address - Country:US
Practice Address - Phone:763-572-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57248946390200000X
MN69798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program