Provider Demographics
NPI:1881843118
Name:AKIODE, OLUTOLA (MBCHB)
Entity Type:Individual
Prefix:
First Name:OLUTOLA
Middle Name:
Last Name:AKIODE
Suffix:
Gender:F
Credentials:MBCHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 S 31ST ST
Mailing Address - Street 2:MAILSTOP MS -01-161B
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508-0001
Mailing Address - Country:US
Mailing Address - Phone:254-724-7633
Mailing Address - Fax:254-724-9280
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:MAILSTOP MS -01-161B
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-7633
Practice Address - Fax:254-724-9280
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.161888207RC0200X
GA003443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine