Healthcare Provider Details

I. General information

NPI: 1063405306
Provider Name (Legal Business Name): ADEWUNMI ABIODUN AKANDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10035 PARK CEDAR DR STE 100
CHARLOTTE NC
28210-8910
US

IV. Provider business mailing address

10035 PARK CEDAR DR STE 100
CHARLOTTE NC
28210-8910
US

V. Phone/Fax

Practice location:
  • Phone: 704-526-0091
  • Fax: 980-237-6858
Mailing address:
  • Phone: 704-526-0091
  • Fax: 980-237-6858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9701215
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number9701215
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: