Provider Demographics
NPI:1033773684
Name:AKINNAWO, OLUWABAMISE RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:OLUWABAMISE
Middle Name:RAYMOND
Last Name:AKINNAWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 VISTA AVENUE
Mailing Address - Street 2:EMERGENCY MEDICINE ADMINISTRATION - 1ST FLOOR(FDT)
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-577-8780
Mailing Address - Fax:314-577-8516
Practice Address - Street 1:3635 VISTA AVENUE
Practice Address - Street 2:EMERGENCY MEDICINE ADMINISTRATION - 1ST FLOOR(FDT)
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-577-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2021035901207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program