Healthcare Provider Details

I. General information

NPI: 1467417592
Provider Name (Legal Business Name): DANITA H. AKINGBA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/07/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26400 W 12 MILE RD SUITE 140
SOUTHFIELD MI
48034-1700
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400 CREDENTIALING
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 248-352-8200
  • Fax: 248-356-8255
Mailing address:
  • Phone: 248-352-8200
  • Fax: 248-356-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01066710A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2008013226
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number4301091011
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: