Healthcare Provider Details

I. General information

NPI: 1144298167
Provider Name (Legal Business Name): FOLUKE ABIODUN OTITOJU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 MINNESOTA DR STE 800
EDINA MN
55435-7915
US

IV. Provider business mailing address

5559 SURREY LN
WAUNAKEE WI
53597-8703
US

V. Phone/Fax

Practice location:
  • Phone: 952-595-1301
  • Fax: 612-294-4903
Mailing address:
  • Phone: 214-356-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0053075
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number48614
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0053075
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number48614-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: