Provider Demographics
NPI:1760672554
Name:OLORIEGBE, FATIMAH ADEBUKOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:FATIMAH
Middle Name:ADEBUKOLA
Last Name:OLORIEGBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FATIMAH
Other - Middle Name:
Other - Last Name:AYINLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 2ND ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3558
Mailing Address - Country:US
Mailing Address - Phone:320-631-7200
Mailing Address - Fax:206-320-5343
Practice Address - Street 1:811 2ND ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3559
Practice Address - Country:US
Practice Address - Phone:320-631-7200
Practice Address - Fax:206-320-5343
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124213207Q00000X
IL125-053767207Q00000X
MN67108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine