Basic Information
| Provider Information | |||||||||
| NPI: | 1881608727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKINJAGUNLA | ||||||||
| FirstName: | OLAKITAN | ||||||||
| MiddleName: | TOMI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11506 BRIGIT CT | ||||||||
| Address2: | |||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207204417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017934776 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 PINE STREET | ||||||||
| Address2: | |||||||||
| City: | TEXARKANA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 75501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037988887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 05/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L2084 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | L2084 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 0101055006 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1881608727 | 05 | VA | MEDICAID | 148976711 | 05 | TX | MEDICAID | 3810012611 | 05 | WV | MEDICAID |