MEDICARE: OLUSEYE AKEEM ADENUSI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	E845001835017	MN

General Provider Information

NPI Number	:	1336606912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUSEYE AKEEM ADENUSI

Provider Business Mailing Address
First Line	:	6609 HILLSBORO AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1862
Country	:	US
Telephone Number	:	763-447-8927
Fax Number	:

Provider Business Practice Location Address
First Line	:	6609 HILLSBORO AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55428-1862
Country	:	US
Telephone Number	:	763-447-8927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2019
Last Update Date	:	03/01/2019

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Directions to “ OLUSEYE AKEEM ADENUSI ” Practice Location

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