Provider Demographics
NPI:1013650811
Name:AKINGBULE, AKINWALE STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:AKINWALE
Middle Name:STEPHEN
Last Name:AKINGBULE
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 1:700 TILGHMAN DR STE 724
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5519
Mailing Address - Country:US
Mailing Address - Phone:417-317-5318
Mailing Address - Fax:417-763-3370
Practice Address - Street 1:700 TILGHMAN DR STE 724
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5519
Practice Address - Country:US
Practice Address - Phone:417-317-5318
Practice Address - Fax:417-763-3370
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2021026653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine