Provider Demographics
NPI:1659339828
Name:BECKLEY, AKINLOLU S (MD)
Entity Type:Individual
Prefix:DR
First Name:AKINLOLU
Middle Name:S
Last Name:BECKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4743 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1113
Mailing Address - Country:US
Mailing Address - Phone:303-449-3642
Mailing Address - Fax:303-440-7299
Practice Address - Street 1:4743 ARAPAHOE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1113
Practice Address - Country:US
Practice Address - Phone:303-449-3642
Practice Address - Fax:303-440-7299
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0055158208600000X, 208600000X
NMMD2012-0222208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82770051Medicaid
CO82770051Medicaid
IA0475483Medicaid
IAI16568Medicare PIN
P00282036Medicare PIN
111204OtherHEALTH ALLIANCE
I47989Medicare UPIN
248560OtherMIDLANDS CHOICE
03217OtherWELLMARK BC/BS