Provider Demographics
NPI:1104079128
Name:LOVELACE, AKINYELE KAMAU (DO)
Entity type:Individual
Prefix:DR
First Name:AKINYELE
Middle Name:KAMAU
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SPRINGFIELD ROAD SUITE 1
Mailing Address - Street 2:FAMILY MEDICINE ASSIOCIATES
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1890
Mailing Address - Country:US
Mailing Address - Phone:413-562-5173
Mailing Address - Fax:413-562-1716
Practice Address - Street 1:75 SPRINGFIELD ROAD SUITE 1
Practice Address - Street 2:FAMILY MEDICINE ASSIOCIATES
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1890
Practice Address - Country:US
Practice Address - Phone:413-562-5173
Practice Address - Fax:413-562-1716
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08486000207R00000X
TXN3151207R00000X
MA261456207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0181935Medicaid
TX8L17414Medicare PIN
NJ139515TM8Medicare PIN