Basic Information
| Provider Information | |||||||||
| NPI: | 1467417592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKINGBA | ||||||||
| FirstName: | DANITA | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 E MAPLE RD | ||||||||
| Address2: | SUITE 400 CREDENTIALING | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483528200 | ||||||||
| FaxNumber: | 2483568255 | ||||||||
| Practice Location | |||||||||
| Address1: | 26400 W 12 MILE RD | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483528200 | ||||||||
| FaxNumber: | 2483568255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01066710A | IN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 174400000X | 2008013226 | MO | N | Other Service Providers | Specialist | 207VF0040X | 4301091011 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000000630236 | 01 | IN | ANTHEM | OTHER | 200953670 | 05 | IN | MEDICAID |