Provider Demographics
NPI:1760451959
Name:AKINDURO, OLUSINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSINA
Middle Name:M
Last Name:AKINDURO
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 1:1901 MELBA DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3017
Mailing Address - Country:US
Mailing Address - Phone:334-794-6611
Mailing Address - Fax:334-794-6614
Practice Address - Street 1:1901 MELBA DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3017
Practice Address - Country:US
Practice Address - Phone:334-794-6611
Practice Address - Fax:334-794-6614
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051523498OtherBLUE CROSS BLUE SHIELD
AL051523498Medicaid
AL051523498Medicaid
AL051523498Medicare PIN
AL051523498OtherBLUE CROSS BLUE SHIELD