Provider Demographics
NPI:1215063938
Name:OYEFESOBI, BANKOLE B
Entity type:Individual
Prefix:MR
First Name:BANKOLE
Middle Name:B
Last Name:OYEFESOBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3489
Mailing Address - Country:US
Mailing Address - Phone:651-644-4979
Mailing Address - Fax:651-644-5705
Practice Address - Street 1:1885 UNIVERSITY AVE W STE 20
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3403
Practice Address - Country:US
Practice Address - Phone:651-644-4979
Practice Address - Fax:651-644-5705
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide