Provider Demographics
NPI: | 1952377723 |
---|---|
Name: | AKINBILE, MUFUTAU (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MUFUTAU |
Middle Name: | |
Last Name: | AKINBILE |
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: | 6189 N PINNACLE RIDGE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | TUCSON |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85718-3502 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 847-530-1350 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6189 N PINNACLE RIDGE DR |
Practice Address - Street 2: | |
Practice Address - City: | TUCSON |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85718-3502 |
Practice Address - Country: | US |
Practice Address - Phone: | 847-530-1350 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-02-23 |
Last Update Date: | 2021-08-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 36105295 | 2080P0203X |
AZ | 55425 | 208D00000X, 2080P0203X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | 690354 | Medicaid | |
IL | K14690 | Medicaid | |
IL | K14691 | Medicare ID - Type Unspecified |