Healthcare Provider Details

I. General information

NPI: 1205522133
Provider Name (Legal Business Name): OMOTOLA NOFISAT AKINADE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS OMOTOLA NOFISAT SHEKONI

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 10/16/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN SUITE 245
LANSING MI
48912
US

IV. Provider business mailing address

745 WONDERLAND ROAD SOUTH 207 POSTAL CODE-N6K1M1
LONDON ONTARIO
N6K1M1
CA

V. Phone/Fax

Practice location:
  • Phone: 517-364-5710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: