Healthcare Provider Details

I. General information

NPI: 1245032994
Provider Name (Legal Business Name): FAVOUR AYOMIDE AKINJIYAN MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 NORTH BALLAS ROAD SUITE 425
SAINT LOUIS MO
63131
US

IV. Provider business mailing address

3005 NORTH BALLAS ROAD SUITE 425
SAINT LOUIS MO
63131
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-4087
  • 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: