Provider Demographics
NPI:1609389675
Name:DOCTOR'S HOUSE
Entity Type:Organization
Organization Name:DOCTOR'S HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEPERO
Authorized Official - Middle Name:OLUFUNMILAYO
Authorized Official - Last Name:OKULAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-836-9412
Mailing Address - Street 1:6565 FRANCE AVE S # 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2137
Mailing Address - Country:US
Mailing Address - Phone:215-668-7199
Mailing Address - Fax:
Practice Address - Street 1:6565 FRANCE AVE S STE 350
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2137
Practice Address - Country:US
Practice Address - Phone:612-836-9412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49342261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center