Provider Demographics
NPI:1740471069
Name:AKAMANGWA, LINUS NGANTE (MD)
Entity type:Individual
Prefix:DR
First Name:LINUS
Middle Name:NGANTE
Last Name:AKAMANGWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 E COSTILLA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3764
Mailing Address - Country:US
Mailing Address - Phone:719-633-8956
Mailing Address - Fax:719-547-6686
Practice Address - Street 1:2150 ACADEMY CIR STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1676
Practice Address - Country:US
Practice Address - Phone:719-645-8137
Practice Address - Fax:719-344-9768
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0058057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000584234OtherBCBS
IN000000604390OtherBCBS
IN200923140Medicaid
IN000000604390OtherBCBS
IN257300DMedicare PIN