Damilola Jakub Agboluaje, MBBS
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · St Louis Park, MN
NPI 1457233256 · NPPES record last updated Jul 23, 2025
Key facts
- NPI
- 1457233256
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 6500 Excelsior Blvd
St Louis Park, MN 55426-4702 - Phone
- (952) 993-5000
- NPI assigned
- Jul 23, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251015000623 | MN | Order and Referring Only - Family Practice |
5496242257 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Mailing address
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-5000
Other providers in St Louis Park, MN
- Advanced Injury Specialists, PLC
- Aeris Medical Group PLLC
- Andrew Michael Aeshliman
- Muhammad Affan
- Afiya Spiritual Life Center, LLC
- Rachel L Agneberg
- Kwao Gareth Ahelegbe
- Hadith Yusuf Ahmed
- Sagal Abdiaziz Ahmed
- Seefen Ahmed
All providers in St Louis Park, MN · Student in an Organized Health Care Education/Training Program in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 23, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.