Healthcare Provider Details

I. General information

NPI: 1144251679
Provider Name (Legal Business Name): AKEEB ADEDOKUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5058 ROMAINE SPRING DR
FENTON MO
63026-5868
US

IV. Provider business mailing address

5058 ROMAINE SPRING DR
FENTON MO
63026-5868
US

V. Phone/Fax

Practice location:
  • Phone: 636-326-2517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2003024384
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2003024384
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: