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Individual

DR. MODUPEOLA OLUFUNMILAYO ADEWUNMI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D

Contact information

Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 293-8269
(651) 293-8195
Mailing address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 293-8269
(651) 293-8195

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11259
ND
207Q00000X
Family Medicine Physician
138899
DC
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
52915
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
11070
ND
01
138899
DC LICENSING
DC
Enumeration date
06/07/2008
Last updated
08/05/2014
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