Individual
DR. OLATUBOSUN FASHORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
323 S MINNESOTA ST, CROOKSTON, MN 56716-1601
(218) 281-9603
(218) 281-9461
Mailing address
323 S MINNESOTA ST, CROOKSTON, MN 56716-1601
(218) 281-9603
(218) 281-9461
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
49513
MN
208D00000X
General Practice Physician
9436
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28040
BCBS ND
—
01
—
946L3FA
BCBS MN
MN
01
—
P00406999
RAILROAD MEDICARE
—
Enumeration date
06/01/2006
Last updated
02/21/2017
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