Provider Demographics
NPI:1144244708
Name:AKIN-WUMI, ALEX-ABBEY (MD)
Entity Type:Individual
Prefix:
First Name:ALEX-ABBEY
Middle Name:
Last Name:AKIN-WUMI
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 1:3336 WOODHILL CIR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-9650
Mailing Address - Country:US
Mailing Address - Phone:313-491-5400
Mailing Address - Fax:313-491-8123
Practice Address - Street 1:4059 W DAVISON
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3262
Practice Address - Country:US
Practice Address - Phone:313-491-5400
Practice Address - Fax:313-491-8123
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108202041OtherBCBS
MI104488126Medicaid
G75274Medicare UPIN
MI104488126Medicaid