Healthcare Provider Details

I. General information

NPI: 1144243247
Provider Name (Legal Business Name): REKIYATU LAWAL UGBOAJAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REKIYATU OHUNENE LAWAL MD

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DELMORE DR
ROSEAU MN
56751-1599
US

IV. Provider business mailing address

2820 MISTY SHORE LN
PFLUGERVILLE TX
78660-7744
US

V. Phone/Fax

Practice location:
  • Phone: 218-463-2500
  • Fax:
Mailing address:
  • Phone: 612-396-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39120
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: