Provider Demographics
NPI:1740446830
Name:AKINBO, OLUWASEUN TEMITOPE
Entity type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:TEMITOPE
Last Name:AKINBO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CANTERBURY DR STE 112
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2258
Mailing Address - Country:US
Mailing Address - Phone:785-261-7599
Mailing Address - Fax:
Practice Address - Street 1:2500 CANTERBURY DR STE 112
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2258
Practice Address - Country:US
Practice Address - Phone:785-261-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-40175207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1740446830Medicaid
CTD400196549Medicare Oscar/Certification