Healthcare Provider Details

I. General information

NPI: 1669967469
Provider Name (Legal Business Name): TIWALADE AKINHANMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 VALLEY VIEW LN
DALLAS TX
75244-5074
US

IV. Provider business mailing address

8910 KEEWATIN RD
LANHAM MD
20706-1908
US

V. Phone/Fax

Practice location:
  • Phone: 469-466-7170
  • Fax:
Mailing address:
  • Phone: 240-918-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: