Individual provider Active NPI

Morenike Fanu

  • Diagnostic Radiology Physician
  • Minneapolis, MN
National Provider Identifier
1720548365
Registry record updated Jun 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
104926 Issued in GA
Practice address
420 Delaware Street SE
MMC 292
Minneapolis, MN 55455
Phone
(612) 626-5589
NPI assigned
Mar 20, 2019
Last updated
Jun 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 72342 MN
Diagnostic Radiology Physician 2085R0202X 104926 GA Primary

Addresses

Primary practice location

420 Delaware Street SE
MMC 292
Minneapolis, MN 55455

Mailing address

350 W Thomas Rd
Phoenix, AZ 85013-4409
Phone (602) 406-4440

Other practice location 1

350 W Thomas Rd
Phoenix, AZ 85013-4409
Phone (602) 406-4440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, GA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240424001676 MN Practitioner - Diagnostic Radiology 5597105593 Reassigns benefits to 4 organizations
I20251229004000 GA Practitioner - Diagnostic Radiology 5597105593 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northside Radiology Associates LLCGroup PAC ID 4486555398, 381 clinicians

Practice addresses (Care Compare)

1000 Johnson Ferry Rd
Atlanta, GA 30342-1606
Phone (404) 662-2438

1000 Johnson Ferry Rd NE
Atlanta, GA 30342-1606
Phone (404) 662-2438

1400 Hembree Rd
Suite 150
Roswell, GA 30076-5711
Phone (404) 851-6577

3359 Glenrose TRL
Atlanta, GA 30341-5783
Phone (404) 662-2438

3400 Old Milton Pkwy
Suite C110
Alpharetta, GA 30005-3769
Phone (404) 851-6577

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
104926GAMDDiagnostic Radiology Physician
72342MNMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Radiology Associates LLC Diagnostic Radiology CurrentSince Oct 16, 2025 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. Current Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Express Care CurrentSince Jun 3, 2024 Accepting new patients
Fairview Clinics CurrentSince Apr 5, 2025 Accepting new patients
University of Minnesota Physicians Current Accepting new patients
Healtheast Medical Research Institute CurrentSince Jun 1, 2024 Accepting new patients
Healtheast Medical Research Institute Current Accepting new patients
Fairview Express Care CurrentSince Jun 3, 2024 Accepting new patients
Fairview Clinics CurrentSince Apr 5, 2025 Accepting new patients

Locations

400 Walmart Way
Ste Fb
Dahlonega, GA 30533
Phone (706) 867-7666

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

14500 99th Ave N
Ste 100
Maple Grove, MN 55369
Phone (763) 898-1000

420 Delaware St SE
#292
Minneapolis, MN 55455
Phone (612) 626-3345

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

720 Washington Ave SE
Ste 200
Minneapolis, MN 55414
Phone (612) 273-8383

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

Interoperability endpoints

  • Direct secure messaging: mfanu503998@fairview.direct-ci.com

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750982400000",
    "number": "1720548365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W THOMAS RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134409",
            "telephone_number": "602-406-4440",
            "fax_number": "602-406-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 DELAWARE STREET SE",
            "address_2": "MMC 292",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-626-5589"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 W Thomas Rd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850134409",
            "country_code": "US",
            "telephone_number": "602-406-4440",
            "fax_number": "602-406-2335",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANU",
        "first_name": "MORENIKE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-20",
        "last_updated": "2025-06-27",
        "certification_date": "2025-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "72342",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "104926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.