Active NPI
Anthonia Adetola Olajide-Kuku, MD
- Pediatrics Physician
- Maple Grove, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 42017
- Practice address
- 7840 Vinewood LN N
Maple Grove, MN 55369-7185 - Phone
- (763) 236-0200
- NPI assigned
- Nov 23, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 42017 | MN | Primary |
Addresses
Primary practice location
7840 Vinewood LN N
Maple Grove, MN 55369-7185
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 416327300 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42017 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Past | Accepting new patients | |
| Allina Health System | Past | Accepting new patients |
Locations
440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225
7840 Vinewood Ln N
Maple Grove, MN 55369
Phone (763) 236-0200
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
11855 Ulysses St NE
Minneapolis, MN 55434
Phone (763) 420-1010
2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813
Interoperability endpoints
- akuku90464@excellian.direct.allina.com
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Allina Health Buffalo Specialty Clinic
- Obstetrics & Gynecology Physician
- Buffalo, MN
- NPI 1295272342
-
dba Allina Health Annandale Clinic
- Family Medicine Physician
- Annandale, MN
- NPI 1457657249
-
dba Allina Health TeleRheumatology
- Rheumatology Physician
- Coon Rapids, MN
- NPI 1952146516
-
dba Allina Health Nicollet Mall Clinic
- Family Medicine Physician
- Minneapolis, MN
- NPI 1467758813
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482883200000",
"number": "1780667717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7840 VINEWOOD LN N",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553697185",
"telephone_number": "763-236-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLAJIDE-KUKU",
"first_name": "ANTHONIA",
"middle_name": "ADETOLA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-23",
"last_updated": "2016-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "42017",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "416327300",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.