Provider Demographics
NPI:1902191240
Name:AKINTOKUNBO, EDITH FATIMA (MD)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:FATIMA
Last Name:AKINTOKUNBO
Suffix:
Gender:F
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:PO BOX 441057
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77244-1057
Mailing Address - Country:US
Mailing Address - Phone:712-714-6488
Mailing Address - Fax:713-583-0708
Practice Address - Street 1:146 ELDRIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3106
Practice Address - Country:US
Practice Address - Phone:713-714-6488
Practice Address - Fax:713-583-0708
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9786207QG0300X, 2083P0011X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GH420OtherBCBS TX
TX355984103Medicaid
TX480898ZWTCMedicare PIN