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General NPI Number Information
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NPI Number | 1609389675
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Entity Type | Organization
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Legal Business Name | DOCTOR'S HOUSE
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 6565 FRANCE AVE S STE 350
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City | EDINA
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State | MN
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Zip | 55435-2137
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Country | US
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Telephone | 612-836-9412
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Fax |
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Provider Business Mailing Address
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Address Line | 6565 FRANCE AVE S # 350
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City | EDINA
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State | MN
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Zip | 55435-2137
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Country | US
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Telephone | 215-668-7199
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADEPERO OLUFUNMILAYO OKULAJA
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Credential | MD
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Telephone | 612-836-9412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 49342
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License Number State | MN
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