Provider Demographics
NPI:1851555460
Name:AKIN-OLUGBADE, OLUYEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUYEMI
Middle Name:
Last Name:AKIN-OLUGBADE
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 1:135 PROFESSIONAL PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-4509
Mailing Address - Country:US
Mailing Address - Phone:681-342-3660
Mailing Address - Fax:681-342-3665
Practice Address - Street 1:135 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-4509
Practice Address - Country:US
Practice Address - Phone:681-342-3660
Practice Address - Fax:681-342-3665
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24685208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology