Provider Demographics
NPI:1518142991
Name:AKINTIDE, ADEDOYIN (MD)
Entity type:Individual
Prefix:
First Name:ADEDOYIN
Middle Name:
Last Name:AKINTIDE
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 1:222 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1179
Mailing Address - Country:US
Mailing Address - Phone:606-783-6500
Mailing Address - Fax:606-783-6878
Practice Address - Street 1:222 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1179
Practice Address - Country:US
Practice Address - Phone:606-783-6500
Practice Address - Fax:606-783-6878
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440376207R00000X, 208M00000X
KY59222207RN0300X
MDD66995208M00000X
VA0101255575207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417447000Medicaid
PA416560OtherUPMC
MDS062-0362OtherBLUE CROSS/BLUE SHIELD - REGIONAL
MD952904-01 & 02OtherBLUE CROSS/BLUE SHIELD
MD952904-01 & 02OtherBLUE CROSS/BLUE SHIELD
MD153796Y1PMedicare PIN