Provider Demographics
NPI:1366468241
Name:AKINTUNDE, OLUYEMISI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUYEMISI
Middle Name:
Last Name:AKINTUNDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MEDICAL DR. SUITE A
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:903-729-2428
Mailing Address - Fax:903-723-7653
Practice Address - Street 1:126 MEDICAL DR. SUITE A
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801
Practice Address - Country:US
Practice Address - Phone:903-729-2428
Practice Address - Fax:903-723-7653
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27348208000000X
IN01070235A208000000X
TXR3631208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3742702-01Medicaid
IN000000844178OtherANTHEM
IN201051670Medicaid
IN201051670Medicaid