Noble Parkway Medical Clinic Professional Corporation

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

NOBLE PARKWAY MEDICAL CLINIC PROFESSIONAL CORPORATION

Practice address

4808 85TH Ave North
Suite 300
Brooklyn Park, MN 55443

Phone

(763) 496-1562

Fax

(763) 657-0581

NPI assigned

Jan 2, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tajudeen O Fawole, MD

Title

Ceo

Phone

(763) 496-1562

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368662400000",
    "number": "1043556517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4808 85TH AVE NORTH",
            "address_2": "SUITE 300",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "55443",
            "telephone_number": "763-496-1562",
            "fax_number": "763-657-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4808 85TH AVE NORTH",
            "address_2": "SUITE 300",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "55443",
            "telephone_number": "763-496-1562",
            "fax_number": "763-657-0581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOBLE PARKWAY MEDICAL CLINIC PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-02",
        "last_updated": "2013-05-16",
        "status": "A",
        "authorized_official_last_name": "FAWOLE",
        "authorized_official_first_name": "TAJUDEEN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-496-1562",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Nienaber, NP-C
• Mallyssa Rose Nissen
• Niya Home Care LLC
• Noble Academy
• Noble Imaging Center, LLC
• Noel'S Hands Healthcare LLC
• Jay Benjamin Nordstrom, PHARMD
• North Clinic, PA
• North Clinic, PA
• North Metro Orthotics and Prosthetics Inc

• Primary Care Clinic/Center in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Primary Care Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.