Provider Demographics
NPI:1346354693
Name:FATOKI, AKINRINOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:AKINRINOLA
Middle Name:
Last Name:FATOKI
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 1:23 CHAMBLEE LN
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7321
Mailing Address - Country:US
Mailing Address - Phone:314-205-2360
Mailing Address - Fax:
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-355-5300
Practice Address - Fax:314-355-1177
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208030767Medicaid
MOF93481Medicare UPIN
MO208030767Medicaid