Provider Demographics
NPI:1053203935
Name:MAKINDE, MICHAEL OLUWASEGUN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:OLUWASEGUN
Last Name:MAKINDE
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:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58107-1332
Mailing Address - Country:US
Mailing Address - Phone:914-486-9429
Mailing Address - Fax:
Practice Address - Street 1:2201 33RD AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6571
Practice Address - Country:US
Practice Address - Phone:914-486-9429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant