Provider Demographics
NPI:1831202167
Name:AKINTAN, BADE (MD)
Entity type:Individual
Prefix:MR
First Name:BADE
Middle Name:
Last Name:AKINTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BADEMOSI
Other - Middle Name:
Other - Last Name:AKINTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 90758
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-0758
Mailing Address - Country:US
Mailing Address - Phone:407-566-9899
Mailing Address - Fax:407-566-9893
Practice Address - Street 1:201 MAGNOLIA AVE SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:863-293-6375
Practice Address - Fax:863-293-8877
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96398208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276351600Medicaid
FL2763516-00Medicaid
FLAA728ZMedicare PIN
FL276351600Medicaid