Provider Demographics
NPI:1063405306
Name:AKANDE, ADEWUNMI ABIODUN (MD)
Entity type:Individual
Prefix:DR
First Name:ADEWUNMI
Middle Name:ABIODUN
Last Name:AKANDE
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 1:10035 PARK CEDAR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8910
Mailing Address - Country:US
Mailing Address - Phone:704-526-0091
Mailing Address - Fax:980-237-6858
Practice Address - Street 1:10035 PARK CEDAR DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8910
Practice Address - Country:US
Practice Address - Phone:704-526-0091
Practice Address - Fax:980-237-6858
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701215207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1100AOtherBLUE CROSS BLUE SHIELD
F97310Medicare UPIN
NC891100AMedicare ID - Type Unspecified
2245531CMedicare ID - Type Unspecified