Provider Demographics
NPI:1467417592
Name:AKINGBA, DANITA H (MD)
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:H
Last Name:AKINGBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400 CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-352-8200
Mailing Address - Fax:248-356-8255
Practice Address - Street 1:26400 W 12 MILE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1700
Practice Address - Country:US
Practice Address - Phone:248-352-8200
Practice Address - Fax:248-356-8255
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066710A207V00000X
MO2008013226174400000X
MI4301091011207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000630236OtherANTHEM
IN200953670Medicaid
IN719300HHMedicare PIN
IN000000630236OtherANTHEM
MDI22563Medicare UPIN
INH60332Medicare UPIN