Provider Demographics
NPI:1669531489
Name:AKINYEDE, ROLAND (MD)
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:
Last Name:AKINYEDE
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 1:144 FRONTENAC FRST
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:MO
Mailing Address - Zip Code:63131-3220
Mailing Address - Country:US
Mailing Address - Phone:314-485-5404
Mailing Address - Fax:314-485-5407
Practice Address - Street 1:3394 MCKELVEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2531
Practice Address - Country:US
Practice Address - Phone:314-485-5404
Practice Address - Fax:314-485-5407
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001025556207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7857612OtherAETNA
MO9352175OtherMERCY HEALTH PLANS
MO266887OtherGHP
MO500204706Medicaid
MO0405742OtherUNITED HEALTH CARE
MO193078OtherANTHEM BLUE CROSS BLUE SH
MO500204706Medicaid
MO924124773Medicare ID - Type Unspecified