Healthcare Provider Details

I. General information

NPI: 1689010985
Provider Name (Legal Business Name): OLISAEMEKA OLIVER AKAMNONU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

3450 WAYNE AVE APT 23H
BRONX NY
10467-2512
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2600
  • Fax:
Mailing address:
  • Phone: 347-337-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number293212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: