Provider Demographics
NPI:1326873308
Name:OBAMI, ANDREW IREYI
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:IREYI
Last Name:OBAMI
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 1:4808 85TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1816
Mailing Address - Country:US
Mailing Address - Phone:763-496-1562
Mailing Address - Fax:763-657-0581
Practice Address - Street 1:4808 85TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1816
Practice Address - Country:US
Practice Address - Phone:763-496-1562
Practice Address - Fax:763-657-0581
Is Sole Proprietor?:No
Enumeration Date:2024-09-07
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily