Provider Demographics
NPI:1407252067
Name:AKINWEKOMI, TAYE
Entity Type:Individual
Prefix:
First Name:TAYE
Middle Name:
Last Name:AKINWEKOMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 S LYNHURST DR
Mailing Address - Street 2:SUITE B 207
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-8621
Mailing Address - Country:US
Mailing Address - Phone:317-243-5824
Mailing Address - Fax:317-243-0111
Practice Address - Street 1:2346 S LYNHURST DR
Practice Address - Street 2:SUITE B 207
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8621
Practice Address - Country:US
Practice Address - Phone:317-243-5824
Practice Address - Fax:317-243-0111
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health