Provider Demographics
NPI:1578533451
Name:ANIMASHAUN, KEHINDE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KEHINDE
Middle Name:
Last Name:ANIMASHAUN
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 1:1852 ASHBURN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6537
Mailing Address - Country:US
Mailing Address - Phone:574-533-5808
Mailing Address - Fax:574-534-7215
Practice Address - Street 1:1852 ASHBURN DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6537
Practice Address - Country:US
Practice Address - Phone:574-533-5808
Practice Address - Fax:574-534-7215
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047198A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200163890Medicaid