Provider Demographics
NPI:1952613051
Name:AKHIGBE, KELVIN OSAGIE (DO)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:OSAGIE
Last Name:AKHIGBE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRACE RD STE F
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2624
Mailing Address - Country:US
Mailing Address - Phone:856-755-1173
Mailing Address - Fax:
Practice Address - Street 1:3023 PERRYTON PKWY STE 202
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2817
Practice Address - Country:US
Practice Address - Phone:806-665-0801
Practice Address - Fax:806-665-8503
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4257207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS4257OtherTEXAS MEDICAL BOARD