Provider Demographics
NPI:1619311586
Name:ADEGOKE, OLUSOLA OLASUPO (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:OLUSOLA
Middle Name:OLASUPO
Last Name:ADEGOKE
Suffix:
Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15290 PENNOCK LN
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7163
Practice Address - Country:US
Practice Address - Phone:952-853-8800
Practice Address - Fax:952-431-6966
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2021-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN59639207Q00000X
WI65487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty