MEDICARE: OLADOTUN OLUSHOLA AKINMURELE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	49044	AL
2	207Q00000X	Family Medicine Physician	342642	LA
3	207Q00000X	Family Medicine Physician	33650	MS
4	207Q00000X	Family Medicine Physician	036170828	IL
5	207Q00000X	Family Medicine Physician	Q1936	TX
6	207Q00000X	Family Medicine Physician	MD2011-02222	NM

General Provider Information

NPI Number	:	1013221969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLADOTUN OLUSHOLA AKINMURELE MD

Provider Business Mailing Address
First Line	:	PO BOX 299
Second Line	:
City	:	PORTALES
State	:	NM
Zip	:	88130-9347
Country	:	US
Telephone Number	:	575-356-6652
Fax Number	:	575-226-0099

Provider Business Practice Location Address
First Line	:	3120 CAPITAL WAY UNIT 602
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-4305
Country	:	US
Telephone Number	:	817-704-3345
Fax Number	:	817-704-3463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	06/17/2025

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