Provider Demographics
NPI:1710181664
Name:AKAHARA, OBIDIKE RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:OBIDIKE
Middle Name:RICHARD
Last Name:AKAHARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 DEVONSHIRE CURV
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-5016
Mailing Address - Country:US
Mailing Address - Phone:612-388-9982
Mailing Address - Fax:186-658-6368
Practice Address - Street 1:1129 DEVONSHIRE CURV
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-5016
Practice Address - Country:US
Practice Address - Phone:612-388-9982
Practice Address - Fax:186-658-6368
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063779A207Q00000X
TXN1974207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine