Healthcare Provider Details

I. General information

NPI: 1669314308
Provider Name (Legal Business Name): AKINWALE A TUNMBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 106TH AVE NW
COON RAPIDS MN
55433-6322
US

IV. Provider business mailing address

1287 106TH AVE NW
COON RAPIDS MN
55433-6322
US

V. Phone/Fax

Practice location:
  • Phone: 612-234-2003
  • Fax:
Mailing address:
  • Phone: 612-234-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305784
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: