Provider Demographics
NPI:1336021138
Name:DAWODU, OLUJIMI MOBOLAJI
Entity type:Individual
Prefix:
First Name:OLUJIMI
Middle Name:MOBOLAJI
Last Name:DAWODU
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 1:3404 84TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2758
Mailing Address - Country:US
Mailing Address - Phone:612-598-5746
Mailing Address - Fax:
Practice Address - Street 1:3404 84TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2758
Practice Address - Country:US
Practice Address - Phone:612-598-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10020104363LP0808X
MN13137363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health