Individual
OLUYEMI ADEBOWALE AJAYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
1200 SIXTH AVE N, CENTRACARE CLINIC, ST CLOUD, MN 56303-2735
(320) 251-2700
(937) 352-3580
Mailing address
1200 SIXTH AVE N, CENTRACARE CLINIC, ST CLOUD, MN 56303-2735
(320) 251-2700
(937) 352-3580
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35090323
OH
208M00000X
Hospitalist Physician
35090323
OH
208M00000X
Hospitalist Physician
Primary
55013
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000530884
ANTHEM
OH
05
—
1972701217
—
MN
05
—
2793080
—
OH
01
—
9164059
AETNA
OH
01
—
P00446750
RAILROAD MEDICARE
OH
Enumeration date
07/09/2007
Last updated
10/30/2015
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