Provider Demographics
NPI:1801991005
Name:FAWOLE, TAJUDEEN OLADAPO (M D)
Entity type:Individual
Prefix:DR
First Name:TAJUDEEN
Middle Name:OLADAPO
Last Name:FAWOLE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4808 85TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1816
Mailing Address - Country:US
Mailing Address - Phone:763-496-1562
Mailing Address - Fax:763-657-0581
Practice Address - Street 1:4808 85TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1816
Practice Address - Country:US
Practice Address - Phone:763-496-1562
Practice Address - Fax:763-657-0581
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine