Healthcare Provider Details

I. General information

NPI: 1316733827
Provider Name (Legal Business Name): DANIELLA ANJOLAOLUWA ODUTAYO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 DELAWARE ST SE
MINNEAPOLIS MN
55455-0341
US

IV. Provider business mailing address

5820 LONG BRAKE TRL
EDINA MN
55439-2622
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-3111
  • Fax:
Mailing address:
  • Phone: 203-819-3094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35467
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: