Provider Demographics
NPI:1689805418
Name:AKINRULI, OMOWUNMI PRAISE (MD, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:OMOWUNMI
Middle Name:PRAISE
Last Name:AKINRULI
Suffix:
Gender:F
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 EMERALDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7826
Mailing Address - Country:US
Mailing Address - Phone:248-346-5444
Mailing Address - Fax:
Practice Address - Street 1:1400 N COIT RD STE 302
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-6656
Practice Address - Country:US
Practice Address - Phone:302-401-0606
Practice Address - Fax:214-433-6327
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009779207Q00000X
TXS1966207Q00000X
FLTPME2484207Q00000X
NJ25MA0885200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0405540Medicaid
NJ355394N4XMedicare PIN