Provider Demographics
NPI:1235362252
Name:AKINWANDE, OLAGUOKE K (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAGUOKE
Middle Name:K
Last Name:AKINWANDE
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 1:12855 N 40 DR STE 205
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8670
Mailing Address - Country:US
Mailing Address - Phone:314-225-2204
Mailing Address - Fax:866-623-8346
Practice Address - Street 1:12855 N 40 DR STE 205
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8670
Practice Address - Country:US
Practice Address - Phone:314-255-2204
Practice Address - Fax:866-623-8346
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160101642086S0129X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO1235362252Medicaid