Individual
DR. OLADEPO COLLINS FASORANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
11475 ROBINSON DRIVE NW - MAILSTOP 32600A, HEALTHPARTNERS COON RAPIDS CLINIC, COON RAPIDS, MN 55433-3746
(763) 587-9000
(763) 587-9130
Mailing address
8170 33RD AVE S, MS21110Q, MINNEAPOLIS, MN 55425-4516
(952) 883-5375
(763) 587-9130
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
001220
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001220
RESIDENCY TRAINING PERMI
GA
01
—
20787
HOSP. PHYSICIAN ID #
GA
Enumeration date
04/07/2007
Last updated
12/05/2011
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