Provider Demographics
NPI:1780794016
Name:OKULAJA, ADEPERO OLUFUNMILAYO (MD)
Entity type:Individual
Prefix:
First Name:ADEPERO
Middle Name:OLUFUNMILAYO
Last Name:OKULAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6565 FRANCE AVE S
Mailing Address - Street 2:STE 350
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2137
Mailing Address - Country:US
Mailing Address - Phone:952-999-4049
Mailing Address - Fax:952-999-4080
Practice Address - Street 1:6565 FRANCE AVE S
Practice Address - Street 2:STE 350
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2137
Practice Address - Country:US
Practice Address - Phone:952-999-4049
Practice Address - Fax:952-999-4080
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI43441207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH40413Medicare UPIN