Provider Demographics
NPI:1417394156
Name:AKINSANYA, OLABODE LATEEF (MD)
Entity Type:Individual
Prefix:DR
First Name:OLABODE
Middle Name:LATEEF
Last Name:AKINSANYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:34616 11TH PL S
Mailing Address - Street 2:STE 4
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8705
Mailing Address - Country:US
Mailing Address - Phone:253-927-2150
Mailing Address - Fax:253-927-2851
Practice Address - Street 1:34616 11TH PL S
Practice Address - Street 2:STE 4
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8705
Practice Address - Country:US
Practice Address - Phone:253-927-2150
Practice Address - Fax:253-927-2851
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301103120207Q00000X
WAMD60629781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8957629Medicare PIN