Individual
MRS. ADETOLA TOLULOLA HAASTRUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1300 S COLUMBIA RD, GRAND FORKS, ND 58201
(701) 780-2300
(701) 780-1942
Mailing address
2401 DEMERS AVE, GRAND FORKS, ND 58201
(701) 780-1891
(701) 780-1942
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301086777
MI
207RN0300X
Nephrology Physician
Primary
11376
ND
207RN0300X
Nephrology Physician
4301086777
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34689000
—
WI
05
—
4779526
—
MI
Enumeration date
02/17/2006
Last updated
03/07/2019
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