MEDICARE: TEMILOLA ABDUL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	59297	MN

General Provider Information

NPI Number	:	1245646116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEMILOLA ABDUL MD

Provider Business Mailing Address
First Line	:	420 DELAWARE STREET SE
Second Line	:	MMC 297
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455
Country	:	US
Telephone Number	:	612-702-9063
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 FORD PKWY STE 200
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3412
Country	:	US
Telephone Number	:	651-696-5000
Fax Number	:	651-696-5005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	10/03/2024

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